Should CTRs be implanted in every patient with PXE?

Cataract surgery in the presence of pseudoexfoliation of the lens (PXE) presents surgeons with many challenges. In addition to a higher incidence of glaucoma, these patients have loss of zonular integrity, occasionally associated with lens subluxation and pupils that dilate poorly.

Most surgeons are currently implanting CTRs only when evidence of zonular instability develops during phacoemulsification. Increasing reports of late IOL/capsular bag subluxation (Figure 2) in patients with PXE4,5 necessitate reevaluating whether CTRs should be placed on an as-needed basis or implanted in every patient with PXE.