From the Research
Patients with pseudoexfoliation syndrome undergoing cataract surgery should be managed with a combination of preoperative, intraoperative, and postoperative strategies to minimize the risk of complications, including the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and careful assessment of zonular weakness and pupillary dilation, as recommended by the most recent study 1.
Preoperative Considerations
- A thorough assessment of zonular weakness and pupillary dilation is essential, with pharmacologic dilation using a combination of tropicamide 1%, phenylephrine 2.5%, and cyclopentolate 1% started 30-60 minutes before surgery.
- Surgeons should plan for potential zonular instability by having capsular tension rings (CTRs) and iris hooks available.
Intraoperative Management
- A careful hydrodissection with minimal pressure, use of dispersive viscoelastic agents, and gentle phacoemulsification with reduced fluidic parameters (bottle height 70-80 cm, vacuum 250-300 mmHg, aspiration flow rate 25-30 cc/min) are recommended.
- Capsular tension rings should be implanted if zonular weakness is observed.
Postoperative Care
- Patients require close monitoring for intraocular pressure spikes using topical pressure-lowering medications like timolol 0.5% twice daily or brimonidine 0.1% three times daily if needed.
- The use of NSAIDs, such as nepafenac, alone or in combination with steroids, can help reduce the risk of pseudophakic cystoid macular edema (PCME) and promote faster recovery from surgery, as shown in the study 1.
- Postoperative care should also include monitoring for other potential complications, such as capsular rupture, vitreous loss, and lens dislocation, and managing them promptly if they occur, as discussed in previous studies 2, 3, 4, 5.