Use of iris retractors can ease lens removal in pseudoexfoliation syndrome

MUNICH, Germany — Enlarging the iris with retractors in patients with pseudoexfoliation syndrome can ease creation of the capsulorrhexis during cataract surgery, according to a surgeon speaking here. The retractors can also be used to steady a loose natural lens during capsule removal.

Charlotta Zetterstrom, MD, of Sweden, discussed the indications and techniques for use of iris retractors and capsular tension rings in a special symposium on pseudoexfoliation here at the European Society of Cataract and Refractive Surgeons meeting.

According to Dr. Zetterstrom, patients with pseudoexfoliation (PEX) syndrome typically develop cataracts earlier than other patients and typically have smaller pupils as well.

She said the biggest problem is that PEX patients have weak zonules, which increases the likelihood of a loose natural lens. This also increases the chance of a loose IOL and subsequent late complications such as IOL displacement.

To overcome these problems, Dr. Zetterstrom said retractors can be used to expand the iris during surgery, and capsular tension rings can increase the stability of chamber.

In addition to expanding the iris, the retractors can also be used to hold the patient’s natural lens steady while the capsulorrhexis is made, she said.

During phacoemulsification, she said, a capsular tension ring can be inserted prior to completing removal of lens material to increase chamber stability. Once the ring is in place, phaco can proceed as normal, she said.

Dr. Zetterstrom warned that PEX patients are prone to late complications, with lens dislocation a particular concern. Because of this, she recommends suturing both the IOL and the capsular tension ring in place in these patients, using 10-0 nylon.

In cases of late IOL dislocation or decentration in pseudophakic patients, the IOL can also be sutured in place and does not have to be removed, she said.