From the Research
Patients with pseudoexfoliation syndrome undergoing cataract surgery should be managed with a combination of pharmacologic dilation, careful surgical technique, and close postoperative monitoring to minimize the risk of complications, as recommended by the most recent study 1.
Preoperative Considerations
- A thorough assessment of zonular weakness and pupillary dilation is essential before surgery.
- Pharmacologic dilation using a combination of tropicamide 1%, phenylephrine 2.5%, and cyclopentolate 1% should be started 30-60 minutes before surgery.
- For poor dilation, intracameral epinephrine (1:10,000) or phenylephrine can be used during surgery.
Intraoperative Considerations
- Surgeons should plan for potential zonular instability by having capsular tension rings (CTRs) and iris hooks available.
- A careful hydrodissection with minimal pressure, creation of a slightly larger capsulorhexis (5.5-6.0 mm), and gentle phacoemulsification with reduced fluidic parameters are recommended.
- Capsular staining with trypan blue may improve visualization of the anterior capsule.
- Intraocular lens selection should favor one-piece acrylic IOLs placed in the capsular bag when possible, with consideration of a CTR for moderate zonular weakness.
Postoperative Considerations
- Patients require close monitoring for intraocular pressure spikes, inflammation, and late complications like IOL decentration or capsular phimosis.
- A standard regimen of topical antibiotics for one week and steroids tapered over 3-4 weeks is typically prescribed, with potential addition of NSAIDs for inflammation control, as supported by the study 1 which found that routine cataract surgery of pseudoexfoliation eyes with nonsteroidal anti-inflammatory drugs (NSAID) alone, or in combination with steroids resulted in faster recovery from surgery and avoidance of pseudophakic cystoid macular edema (PCME) compared to steroids alone.
- The use of NSAIDs, such as nepafenac, in combination with steroids, has been shown to reduce the risk of PCME and promote faster recovery from surgery 1.
Key Recommendations
- Use of NSAIDs in combination with steroids for postoperative inflammation control 1.
- Close monitoring for intraocular pressure spikes, inflammation, and late complications.
- Careful surgical technique, including careful hydrodissection and gentle phacoemulsification.
- Use of capsular tension rings and iris hooks for potential zonular instability.