title: Pseudoexfoliation: High risk factors for zonule weakness and concurrent vitrectomy during phacoemulsification.
abstract: OBJECTIVE
  To assess the frequency and results of cataract surgery with concurrent vitrectomy due to zonule weakness in eyes with pseudoexfoliation (PXF).
  
  
  METHODS
  Private practice, Boston, Massachusetts, USA.
  
  
  METHODS
  This retrospective nonrandomized study assessed consecutive eyes with PXF having cataract surgery. High risk was defined as preoperative phacodonesis, iridodonesis, or lens subluxation (subgroup 1); preoperative anterior chamber depth or angle-depth asymmetry between eyes confirmed by slitlamp biomicroscopy or gonioscopy, respectively (subgroup 2); or complicated cataract extraction related to zonule weakness in the fellow eye (subgroup 3). Exclusion criteria were previous vitrectomy, scleral buckle, or trabeculectomy surgery and combined cataract-glaucoma surgery. A comparative analysis of outcome parameters was performed.
  
  
  RESULTS
  Of the 1059 eyes evaluated, 38 had vitrectomy. Concurrent vitrectomy was required in 19 (15.6%) of 122 high-risk eyes and 19 (2.0%) of 937 non-high-risk eyes (P<.00001). The need for concurrent vitrectomy was greatest in subgroup 3 (72.7%) and subgroup 1 (42.9%). There was no statistically significant difference between the vitrectomy group and the no-vitrectomy group in the mean improvement in logMAR corrected distance visual acuity (CDVA) (P = .38) or mean change in intraocular pressure (IOP) (mean decrease 2.6 mm Hg +/- 1.5 [SD] and 1.6 +/- 0.5 mm Hg, respectively) (P = .47).
  
  
  CONCLUSIONS
  Despite the need for vitrectomy and the attendant increased demands in postoperative care, both the vitrectomy group and no-vitrectomy group had improved logMAR CDVA and IOP.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: Center for Eye Research and Education, Boston, Massachusetts 02114, USA. bjshingleton@eyeboston.com
authors.forename: Bradford J
authors.initials: BJ
authors.lastname: Shingleton
authors.forename: Alicia C
authors.initials: AC
authors.lastname: Marvin
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Heier
authors.forename: Mark W
authors.initials: MW
authors.lastname: O'Donoghue
authors.forename: Anupam
authors.initials: A
authors.lastname: Laul
authors.forename: Brian
authors.initials: B
authors.lastname: Wolff
authors.forename: Anne
authors.initials: A
authors.lastname: Rowland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017889:Exfoliation Syndrome / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D007431:Intraoperative Complications; D008022:Ligaments / Q000473:pathology*; D008297:Male; D018918:Phacoemulsification; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy