Large pupil, rhexis can improve cataract surgery in presence of pseudoexfoliation

MUNICH, Germany — Modifications of cataract surgical technique may be helpful in patients with pseudoexfoliation syndrome, a speaker here said.

Adapting the surgical procedure to the condition of the patient can lead to better postoperative outcomes, said Albert Galand, MD, of Liege, Belgium. He spoke on performing phacoemulsification and implanting foldable IOLs in patients with pseudoexfoliation (PEX) here at the European Society of Cataract and Refractive Surgeons meeting.

“One of the major problems in performing phacoemulsification on PEX patients is postoperative IOL dislocation due to zonal dehiscence during lens removal and cortical cleanup,” Dr. Galand said. “This risk is enhanced when there is a small pupil and small rhexis.”

The iris can be efficiently expanded by simple stretching and injection of a heavy viscoelastic, Dr. Galand said. The dilation will persist until the end of the procedure, and iris retractors may not be needed, he said.

Safety can be increased during capsulorrhexis by using a heavy viscoelastic, he said. Forceps or scissors can then be used to gently and slowly peel back the capsule.

According to Dr. Galand, almost any phaco technique can be used to remove the lens in these patients. However, he warned that the lens should be moved forward to prevent it from dropping into the vitreous.

He said it is also better to perform phaco in these patients using a small-incision procedure and with small-diameter instruments, with irrigation placed in the center of the chamber.

He recommended choosing an IOL with haptics that provide extensive contact with the capsular bag. “The haptics can then act as capsular tension segments and help increase postop lens stability,” he said.