Pseudoexfoliation of lens capsule, Glaucoma

Pseudoexfoliation of lens capsule

Pseudoexfoliation cataract

Pseudoexfoliation and cataract surgery

Pseudoexfoliation after cataract surgery

Pseudoexfoliation and pigment dispersion

Pseudoexfoliation and glaucoma

Pseudoexfoliation

Pseudoexfoliation syndrome is an age-related systemic eye problem that affect ocular tissues through the gradual deposition of fibrillary white flaky material from the crystelline lens, mainly on the lens capsule, ciliary body, zonules, corneal endothelium, iris and pupillary margin.

Pseudoexfoliation is also called as PXF and PEX.

It is very common eye problem seen in cataract diagnosed patient in preoperative examination.

Causes of Pseudoexfoliation

The causes of Pseudoexfoliation is a well-recognized late-onset disease caused by a generalized fibrillopathy. 

It is ocular complications including glaucoma and perioperative problems during cataract surgery.

Diagnosis of PXF

Diagnosis of Pseudoexfoliation is made using slit lamp biomicroscopy or under operative microscope and intraocular pressure measurement (IOP). 

Deposition of white fluffy material on the anterior lens capsule and pupillary margin and iris transillumination defects can be visualized in many cases. 

Gonioscopy may show increased pigment deposit on the trabecular meshwork of ciliary body.

Physical examination

Examination for  Pseudoexfoliation with following point should be remembered...

• Increased intraocular pressure more than 21 mmhg

• Possible glaucomatous damage to optic nerve

• Poor dilation with peripupillary transillumination defect

• Fibrillar white flaky deposits on the anterior lens capsule

• Fibrillar white flaky deposits on at pupillary border

• Hyperpigmentation of the trabecular meshwork with an open angle on gonioscopy

Management of PXF syndrome

1. Routine regular eye exam

2. Glaucoma monitoring and treatment if diagnosed

3. Special surgical considerations for cataract surgery pre-operatively, intra-operatively and post-operatively

Best medical tretment for PXF

1. Installed eye drops if the patient has glaucoma or glaucomatous symptoms.

2. Possible use of antioxidants 

3. Lower Homocysteine if the level is high in plasma or tear film

Complications due to PXF

1. Glaucoma or optic nerve cupping

2. Cataract surgery complications:

• Drop nucleus or lens fragment

• Zonular dialysis

• Zonular weakness with or without phacodonesis

• Lens subluxation

3. Other systemic problems