Complications of cataract surgery in eyes withpseudoexfoliation syndrome

Aim: Retrospective investigation of complications of cataract surgery in eyes with pseudoexfoliation syndrome Materials and Methods: This study was conducted retrospectively by using medical records of patients who applied to Rize Recep Tayyip Erdogan University Training and Research Hospital Ophthalmology Clinic between 05.06.2017 and 13.01.2020, with and without PES, who had undergone cataract surgery, retrospectively. The cases diagnosed with pseudoexfoliation syndrome (PES) were classified as the PES group, and the other cases as the control group. 130 eyes of 112 patients with PES who underwent cataract surgery were included in the PES group; 137 eyes of 101 patients who underwent cataract surgery were included in the control group. IBM SPSS Statistics 23.0 package program was used for statistical evaluation. Results: The mean age of the PES group was 76.65±8.58 years, 67.9% male, 32.1% female, and 84% unilateral. The mean age of the control group was 71.11±8.88. The mean age of the PES group was statistically significantly higher than the control group. The incidence of hypertension was 45.5% in the PES group and 29.7% in the control group. The incidence of hypertension was statistically significantly higher in the PES group than in the control group. In the PES group, 28.5% nuclear cataract, 13.1% mature cataract and 14.6% corticonuclear cataract were detected. In the control group, 21.9% nuclear cataract, 5.1% mature cataract and 30.7% corticonuclear cataract were detected. The incidence of nuclear and mature cataracts was statistically significantly higher in the PES group, while corticonuclear cataracts were lower. Among the intraoperative complications, posterior capsular rupture (ARR), vitreous loss, and zonule detachment were 3.8%, 4.6%, and 4.6% in the PES group, and 0.7%, 0.7%, and 0% in the control group, respectively. There was no significant difference in intraoperative complication rate between PES and control groups. While loose iris syndrome was not seen in the PES group, it was detected in 2 (1.5%) eyes in the control group. Nucleus falling into the vitreous and capsular block syndrome were not observed in both PES and control groups. Pupil diameter after dilation was middilated in all eyes in the PES group; In the control group, 127 (92.7%) eyes were good, 9 (6.6%) middilated, and 1 (0.7%) weak. Sphincterotomy was used in 12 (9.2%) eyes and iris hook was used in 13 vi (10.0%) eyes in the PES group to manage weak dilatation. The mean visual acuity on postoperative day 1 was 0.32 ±0.2 in the PES group and 0.47±0.27 (in decimal order) in the control group. It was observed that the mean visual acuity was lower in the PES group compared to the control group, with a statistically significant difference. The mean postoperative first day intraocular pressure (IOP) was 20.40±8.97 mmHg in the PES group and 18.04±5.22 mmHg in the control group, and there was no statistically significant difference between the two groups. It was found that corneal edema, one of the postoperative complications, was seen with a statistically significant difference in the PES group. Again, among the postoperative complications, pupillary membrane, fibrinoid reaction, Descemet's wrinkle, capsular phimosis, tilt and subluxation of the lens were more common in the PES group; There was no statistically significant difference between the two groups in terms of these complications. Posterior capsule opacification (PCO) was detected in 3 (2.3%) eyes in the PES group and in 3 (2.2%) eyes in the control group. There were no eyes with retinal detachment or choroidal detachment in either group. Conclusion: PES is a syndrome characterized by the systemic accumulation of gray-white fibrinogranular PEM as well as intraocular tissues. Its accumulation in the intraocular tissues causes an increased incidence of glaucoma and an increase in the rate of intra- and postoperative complications in cataract surgery. In patients who are planned for cataract surgery, the increased risk can be minimized by determining the level of accumulation in the intraocular tissues and the pathological changes it causes before the operation, by careful examination, and by the experienced surgeon making preparations accordingly and applying the necessary interventions during the surgery. Key words: Pseudoexfolation Syndrome, Cataract, Glaucoma, Surgery, Complication