title: Outcome of phacoemulsification and intraocular lens implantion in eyes with pseudoexfoliation and weak zonules.
abstract: OBJECTIVE
  To evaluate the results of phacoemulsification and intraocular lens (IOL) implantation in eyes with pseudoexfoliation (PEX) and zonular weakness.
  
  
  METHODS
  Two hundred and ninety-five patients (295 eyes) were recruited. This study is a retrospective case review of 143 PEX eyes with preoperative (Group 1) and intraoperative (Group 2) signs of zonular weakness, 76 PEX eyes (Group 3) and 76 non-PEX eyes without zonular weakness (Group 4) undergoing phacoemulsification and IOL implantation performed by single surgeon from year 1988 to 2010. Outcome measures included frequency of postoperative pseudophakodonesis, anterior capsule contraction and IOL decentration/dislocation. Postoperative vision, intraocular pressure (IOP) and glaucoma medication requirements were also assessed. A subanalysis on identical postoperative outcomes of capsular tension ring (CTR) implantation was performed. Comparisons were made for 52 PEX eyes with zonular weakness receiving nonsutured CTR implantation (Group A), 91 PEX eyes with zonular weakness not receiving CTR implantation (Group B) and 142 PEX eyes without zonular weakness (Group C).
  
  
  RESULTS
  Mean follow-up was 4.08 ± 0.48 years and maximum was 8.3 years. Both Groups 1 and 2 showed higher incidence of complications than Groups 3 and 4 (p < 0.01). Vision, IOP and glaucoma medication requirements were similar postoperatively for all four groups. Groups A and B had a significantly higher proportion of postoperative complications than Group C (p < 0.01). There was no significant difference in risk of developing these complications between Groups A and B (p = 0.64).
  
  
  CONCLUSIONS
  Postoperative complication rates are higher in PEX eyes with preoperative and/or intraoperative signs of zonular weakness undergoing phacoemulsification. Nonsutured CTR implantation does not prevent IOL and capsular complications postoperatively.
authors.affiliation: Ophthalmic Consultants of Boston, Center for Eye Research and Education, Boston, Massachusetts, USA.
authors.forename: Bradford J
authors.initials: BJ
authors.lastname: Shingleton
authors.affiliation: Academic Unit of Ophthalmology, Ninewells Hospital and Dundee Medical School, Dundee, UK.
authors.forename: Yan Ning
authors.initials: YN
authors.lastname: Neo
authors.affiliation: Ophthalmic Consultants of Boston, Center for Eye Research and Education, Boston, Massachusetts, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Cvintal
authors.affiliation: Ophthalmic Consultants of Boston, Center for Eye Research and Education, Boston, Massachusetts, USA.
authors.forename: Alicia Marvin
authors.initials: AM
authors.lastname: Shaikh
authors.affiliation: Ophthalmic Consultants of Boston, Center for Eye Research and Education, Boston, Massachusetts, USA.
authors.forename: Paulina
authors.initials: P
authors.lastname: Liberman
authors.affiliation: Ophthalmic Consultants of Boston, Center for Eye Research and Education, Boston, Massachusetts, USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: O'Donoghue
mesh_terms: D000368:Aged; D017889:Exfoliation Syndrome / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D019654:Lens Implantation, Intraocular / Q000379:methods*; D007908:Lens, Crystalline / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D009887:Ophthalmoscopy; D018918:Phacoemulsification / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors
keywords: capsular tension ring; cataract; phacoemulsification; postoperative complications; pseudoexfoliation; weak zonules