2966: resident case of pseudo-exfoliation
This case features an anonymous resident surgeon tackling a classic and often tough scenario: cataract surgery in an eye with pseudo-exfoliation syndrome (PXF). Looking closely at the preoperative red reflex and anterior segment presentation, we can immediately begin to predict the specific hurdles this trainee will face. First, look at the pupil dilation—or lack thereof. PXF is notorious for causing poor pupillary dilation due to iris stroma infiltration and fibrotic changes, which can limit surgical visualization. Second, note the subtle pseudo-exfoliative material deposits on the anterior lens capsule. This hallmark finding is your warning sign for possible generalized zonulopathy. In these resident cases, weak zonules mean the capsular bag can shift or tear during the capsulorhexis, hydrodissection, or phacoemulsification steps. This video serves as an excellent teaching tool on how to preemptively anticipate zonular instability and poor dilation, ensuring the resident is prepared to alter their technique or insert capsular support devices before a complication occurs.
