Take-home: Cataract surgery in eyes with pseudoexfoliation syndrome is associated with increased intraoperative and postoperative risks. Strategies for improving outcomes include attention to IOL selection, and one surgeon describes why he is using a particular IOL.
Brooklyn, NYâEyes with pseudoexfoliation syndrome (PXF) present multiple challenges for cataract surgery as they are at increased risk for a number of complications during and after the procedure. Zonular weakness is a key issue in these cases as it affects both intraoperative safety and postoperative IOL stability.
According to Leonard M. Bley, MD, multiple features of a particular single-piece hydrophobic acrylic IOL (enVista, Bausch+Lomb) make it an excellent choice for implantation in eyes with PXF.
Dr. Bley is Surgical Director, NYLASIK Laser & Microsurgery Institute, New York, NY, and sees many patients of eastern European and Russian heritage among whom PXF is common. After switching to using the enVista IOL for eyes with PXF about 12 months ago, Dr. Bley estimates he has implanted it in about 200 cases either alone or with a capsular tension ring. So far, he is very satisfied with the outcomes.
âLonger follow-up is needed because eyes with PXF are at risk for late IOL dislocation due to progressive zonular weakness and anterior capsule phimosis. However, I believe the unique material of the enVista IOL will help limit these complications, and its performance has been very promising,â he told Ophthalmology Times.
Dr. Bley said that in eyes with PXF, placement of a capsular tension ring to expand the capsular bag intraoperatively is important for increasing the safety of cataract removal in eyes with frank zonular dehiscence. Leaving the CTR in the eye can also help maintain capsule stability, although it does not prevent late IOL dislocation.
The benefit of using the enVista IOL in eyes with PXF relates to the fact that the lens is constructed of a relatively stiff hydrophobic acrylic material. Consequently, it can act to keep the capsular bag expanded and help to resist the forces created through capsular bag contraction that can lead to zonular dehiscence.
âEspecially in cases where a CTR is not used, an IOL that is made of a very stiff material essentially acts like a CTR to help to keep the bag open,â Dr. Bley said.