INCIDENCE OF PSEUDOEXFOLIATION SYNDROME AND GLAUCOMA IN A SET OF MORE THAN 14,000 EYES OF PATIENTS OPERATED FOR A CATARACT

Abstract

Purpose: Evaluation of the incidence of pseudoexfoliation (PEX) syndrome and glaucoma in cataract patients operated in our clinic with analysis of possible complications. Methodology: Retrospective evaluation of medical documentation of patients with PEX syndrome who underwent cataract surgery at the Gemini Eye Clinic Ostrava-Hrušov. The study period was from November 2016 to April 2021. The monitored parameters were the incidence of PEX syndrome, age and sex of the patients, the value of intraocular pressure (IOP) before the procedure, pre-existed therapy of previously diagnosed secondary glaucoma and the eventual occurrence of perioperative complications. Results: In the monitored period of 4.5 years, out of the total number of 14,167 operated eyes with cataracts 852 eyes of 689 patients with PEX syndrome were diagnosed at our clinic, i.e. 6.0%. The mean age was 76.9 years, the median 77 years, ranging from 54–100 years. The observed pathology was more common in women at a ratio of 1.84:1 (552:300). Elevation of IOP above 21 mmHg was recorded in 118 eyes, in 14 of them IOP reached values over 30 mmHg. Diagnosed and long-term treated secondary glaucoma was confirmed by 153 patients (204 eyes), of which 22 eyes underwent antiglaucoma laser (19 eyes) and / or surgery (5 eyes) in the anamnesis. Perioperatively, in 231 eyes we recorded the following pathological findings accompanying the occurrence of PEX syndrome – most often poor artificial mydriasis (189 eyes), subluxation of the lens (31 eyes) or zonular fragility (17 eyes). To reduce the risk of perioperative and postoperative complications, implantation of a capsular tension ring was indicated in 20 eyes. Complications during the procedure occurred in 11 eyes, of which 8 eyes were diagnosed with advanced cataracts. Conclusions: PEX syndrome and glaucoma are relatively common diseases that can complicate the lives of patients and eye surgeons. The incidence of PEX syndrome in our cataract patients was 6%. Proper diagnosis of this disease is important not only for the possible occurrence of numerous complications during and after cataract surgery, but also for the possible presence of secondary glaucoma. It also serves to detect possible involvement of the contralateral eye. In addition, due to the involvement of practically all tissues in the body, the patient is endangered by numerous, especially vascular comorbidities. For these reasons, we find it appropriate to observe these patients by other specialists. In our experience, early indication for cataract surgery for a lower degree of zonular fragility and a softer lens core is important. In addition, lower levels of pro-inflammatory pseudoexfoliating material occur in the anterior segment of the eye in the early stages, which may have a beneficial effect on postoperative healing.