Early lensectomy in patients with pseudoexfoliation: long-term outcomes of effectiveness and safety

Abstract

Purpose : Capsular pseudoexfoliation (PEX) is a heterogeneous syndrome that can present as a wide variety of clinical scenarios and early lensectomy may help to reduce comorbidity in some of them. This study aimed to assess the long-term effectiveness, predictability and safety of cataract surgery in patients presenting whether symmetric or asymmetric PEX.

Methods : A retrospective, observational clinical study was designed, including PEX patients that underwent phacoemulsification with hydrophobic acrylic intraocular lens (IOL) implantation in both eyes at one centre between 2001 and 2015. Multifocal IOL were only implanted in selected cases of asymmetric PEX. A postoperative follow-up ≥5 years, ≥3 preoperative reliable visual field (VF) tests and the presence of periodical VF tests until the analysis visit were required.
322 eyes of 161 patients were included (mean age: 71.4±5.7 years), with a mean follow-up time of 8.5±2.8 years (range: 6-17 years). Patients were classified in two groups: 102 patients with symmetric PEX (PEX material seen in both eyes with the slit lamp), and 118 patients with asymmetric PEX (only one eye presented clinically apparent PEX).
Preoperative and postoperative visual acuity, intraocular pressure (IOP), number of hypotensive drugs and VF mean deviation (MD) were registered, as well as the appearance of intraoperative and postoperative complications. Wilcoxon test was used for statistical analysis.

Results : Before surgery, no statistical differences were found between both groups. Postoperatively, 95%, 96% and 96% of eyes were within ±1.00D in symmetric PEX, asymmetric PEX with monofocal IOL, and asymmetric PEX with multifocal IOL groups, respectively.
At the final follow-up visit, IOP remained stable in the main two groups (p=0.08; p=0.06) with a reduction of the number of medications (p<0.001). MD worsened from -8.8 dB to -11.6 dB in the symmetric group (p<0.001), and remained stable in the asymmetric group (from -5.0 dB to -7.1 dB; p=0.42). No intraoperative complications were registered in the asymmetric group, in comparison with the symmetric group: 7 (3.4%; p=0.05). Ten cases (4.9%) of late IOL dislocation were found, only in the symmetric group (p=0.04).

Conclusions : Early lensectomy with IOL implantation in patients with PEX before its symmetric presentation results effective, safe and predictable in the long term.

This is a 2021 ARVO Annual Meeting abstract.