Cataract surgery in patients with Pseudoexfoliation syndrome: Challenges and outcomes from a tertiary healthcare center.
Surabhi Juikar
, Shubhangi P Nigwekar , Manasvini Kapadia
Pseudoexfoliation syndrome, PXF, Cataract surgery in PXF, Intraoperative Complications
ABSTRACT
Purpose:
To study intraoperative challenges and surgical outcomes in patients with pseudoexfoliation syndrome (PXF) undergoing senile cataract surgery.
Materials and methods: An observational, descriptive, prospective study was conducted on 30 patients diagnosed with pseudoexfoliation over a period of one year (January 2024–January 2025) at a rural tertiary healthcare centre, following ethical approval. Written informed consent was obtained in the local language. Patients aged >40 years with PXF undergoing senile cataract surgery were included, while those with other ocular diseases or a history of previous ocular surgery were excluded. Data regarding age and gender distribution, intraocular pressure (IOP), pupillary dilation, intraoperative and postoperative complications, management techniques and postoperative visual outcomes were collected and studied.
Results: Thirty patients were included, with the majority in 71–80 year age group 56.61% (17 patients). Intraoperatively, pupillary dilation of < 4mm was achieved in 33.3% (10 patients), 4–6 mm in 39.96% (12 patients), while ≥6 mm dilation was obtained in 26.64% (8 patients). Topical tropicamide and intracameral adrenaline were used in all cases; Visco-mydriasis was required in 86.58% (26 patients) while additional mechanical pupillary stretching using two-dialer method and using iris hooks was done in 73.26% (22 patients) and 13.32% (4 patients) respectively. Adjunctive procedure included sphincterotomy in 16.65% (5 patients). Intraoperative complications included zonular dialysis 13.32% (4 patients), posterior capsular rent 9.99% (3 patients) and vitreous loss 3.33% (1 patient). In 6.66% (2 patients) mild zonular dialysis of <4 clock hours was present. Out of which 1 patient was treated with sulcus-fixated IOL and the other patient was treated with capsular tension ring with in the bag IOL. There were 6.66% (2 patients) having zonular dialysis of >4 clock hours. One patient was treated with vitrectomy with primary SFIOL and the other patient was treated with vitrectomy with secondary SFIOL after 3 weeks postoperatively. Posterior capsular rent was seen in 9.99% (3 patients) out of which 2 patients without vitreous loss were treated with sulcus fixation IOL while 1 patient who had vitreous loss too was managed with vitrectomy and primary SFIOL. On postoperative day one, 53.28% (16 patients) achieved visual acuity of 6/6–6/18, 39.96% (12 patients) had 6/18- finger counting (FC) 6 meters, and 6.66% (2 patients) had vision of FC at 6 meters-FC at 3 meters. Corneal edema and irregular pupil were the frequent postoperative findings in 19.98% (6 patients) and 13.23% (4 patients) respectively, whereas decentered IOL occurred in 3.33% (1 patient).
Conclusion: Patients with PXF present with significant surgical challenges due to poor pupillary dilation and weak zonules, increasing the risk of intraoperative complications like zonular dialysis, posterior capsular rent and vitreous loss. Despite these challenges, alternate techniques like use of intracameral adrenaline, mechanical stretching with two-dialer method and use of iris hooks and sphincterotomy can be considered. One can expect favourable postoperative visual outcome with timely management of zonular instability and small non-dilating pupil.
"Cataract surgery in patients with Pseudoexfoliation syndrome: Challenges and outcomes from a tertiary healthcare center.", IJSDR - International Journal of Scientific Development and Research (www.IJSDR.org), ISSN:2455-2631, Vol.11, Issue 1, page no.b161-b169, January-2026, Available :https://ijsdr.org/papers/IJSDR2601118.pdf
Volume 11
Issue 1,
January-2026
Pages : b161-b169
Paper Reg. ID: IJSDR_306912
Published Paper Id: IJSDR2601118
Downloads: 000205
Research Area: Humanities All
Country: Raigad, Maharashtra, India
ISSN: 2455-2631 | IMPACT FACTOR: 9.15 Calculated By Google Scholar | ESTD YEAR: 2016
An International Scholarly Open Access Journal, Peer-Reviewed, Refereed Journal Impact Factor 9.15 Calculate by Google Scholar and Semantic Scholar | AI-Powered Research Tool, Multidisciplinary, Monthly, Multilanguage Journal Indexing in All Major Database & Metadata, Citation Generator
Publisher: IJSDR(IJ Publication) Janvi Wave
