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Pseudoexfoliation (PXF) can increase the complexity of cataract surgery because of zonular weakness and limited pupillary dilation. A prospective study specifically examining eyes with PXF identified preoperative features associated with higher risk of zonular complications requiring scleral IOL fixation or capsular tension ring placement. Important predictors included smaller pupil diameter after dilation, shallower anterior chamber depth, and greater lens decentration. These findings provide a practical preoperative checklist for surgeons managing PXF eyes. Rather than treating PXF as a binary risk label, the study supports a more granular assessment of actual zonular and biometric features. Intraoperative preparedness can then be tailored accordingly, including consideration of capsular support devices, pupil expansion strategies, and contingency planning for alternative IOL fixation. The message is particularly relevant for challenging cataract instruction courses because small-pupil behavior, capsular instability, and lens decentration may interact to make otherwise routine phaco more demanding. Careful assessment before surgery can reduce surprises and allow the surgeon to choose instrumentation and backup options in advance.
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Pseudoexfoliation (PXF) can increase the complexity of cataract surgery because of zonular weakness and limited pupillary dilation. A prospective study specifically examining eyes with PXF identified preoperative features associated with higher risk of zonular complications requiring scleral IOL fixation or capsular tension ring placement. Important predictors included smaller pupil diameter after dilation, shallower anterior chamber depth, and greater lens decentration. These findings provide a practical preoperative checklist for surgeons managing PXF eyes. Rather than treating PXF as a binary risk label, the study supports a more granular assessment of actual zonular and biometric features. Intraoperative preparedness can then be tailored accordingly, including consideration of capsular support devices, pupil expansion strategies, and contingency planning for alternative IOL fixation. The message is particularly relevant for challenging cataract instruction courses because small-pupil behavior, capsular instability, and lens decentration may interact to make otherwise routine phaco more demanding. Careful assessment before surgery can reduce surprises and allow the surgeon to choose instrumentation and backup options in advance.
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