From the Research
Managing PXF-affected corneas during surgical interventions or episodes of raised intraocular pressure requires careful preoperative assessment and specific intraoperative techniques, prioritizing the use of dispersive viscoelastic agents and maintaining adequate anterior chamber depth to minimize complications, as supported by the most recent study 1. When managing PXF-affected corneas, it is essential to consider the potential risks and complications associated with surgical interventions and episodes of raised intraocular pressure. The most recent study 1 highlights the importance of careful preoperative assessment and specific intraoperative techniques to minimize complications.
Key Considerations
- Before surgery, thoroughly evaluate the corneal endothelium with specular microscopy as PXF patients often have compromised endothelial cell counts.
- During cataract surgery, use dispersive viscoelastic agents like Viscoat or DisCoVisc to protect the corneal endothelium, and maintain adequate anterior chamber depth throughout the procedure.
- For phacoemulsification, employ lower ultrasound energy settings with longer phaco times rather than high-energy bursts.
Medical Therapy
- When managing elevated intraocular pressure in PXF patients, first-line medical therapy typically includes prostaglandin analogs (latanoprost 0.005% once daily) or aqueous suppressants (timolol 0.5% twice daily) 2.
- These patients often require more aggressive IOP management due to their higher risk of glaucoma progression.
Surgical Interventions
- Selective laser trabeculoplasty (SLT) is particularly effective in PXF glaucoma, with success rates of 70-80% 2.
- The cumulative incidence of IOL dislocation over 20 years was significantly higher in patients with PXF than without PXF before surgery, highlighting the need for careful management and follow-up 1.
Corneal Protection
- For corneal protection during episodes of elevated IOP, consider sodium hyaluronate 0.1-0.3% eye drops 3-4 times daily to support endothelial function.
- The underlying mechanism of corneal vulnerability in PXF involves accumulation of fibrillar material on the corneal endothelium, reducing cell density and function, which explains why these corneas are more susceptible to surgical and pressure-related trauma 3.