Pseudoexfoliation Syndrome – Review of Current Reports in Terms of Preoperative Assessment, Intraoperative Complications and Innovative Technologies Used in Cataract Surgery
Autorzy: Katarzyna Gontarz1,2, Ewa Mrukwa-Kominek1,2
1. Klinika Okulistyki Katedry Okulistyki Wydziału Nauk Medycznych w Katowicach Śląskiego Uniwersytetu Medycznego w Katowicach
Kierownik: prof. dr hab. n. med. Ewa Mrukwa-Kominek
2. Oddział Okulistyki Dorosłych Uniwersyteckiego Centrum Klinicznego im. prof. K. Gibińskiego Śląskiego Uniwersytetu Medycznego w Katowicach
Kierownik: prof. dr hab. n. med. Ewa Mrukwa-Kominek.
Pseudoexfoliation syndrome is still an ongoing problem in cataract surgery. It is associated with its high frequency among cataract patients and simultaneously increased risk of intra- and postoperative complications. Much research concerns the pre-and intraoperative implications of cataract surgery complicated by pseudoexfoliation syndrome. The paper presents the basics of the current knowledge and analyzes the latest literature reports on the preoperative assessment and intraoperative complications of patients with cataract complicated by pseudoexfoliation syndrome. These complications are mainly the result of: a small pupil, fragility of the lens capsule and weakness of the zonular apparatus.
Currently, basic research is constantly conducted in each of these areas, such as the assessment of: static and dynamic pupillometry, mechanical properties of the lens capsule, or the anterior chamber depth in various subpopulations of pseudoexfoliation syndrome patients. They provide the basis for the proper assessment of prognosis, surgery planning (possibly with the use of supporting instruments and techniques), as well as progress in the development of new technologies. The paper highlights these innovative technologies, the attempts of which to apply in patients with cataracts complicated by pseudoexfoliation syndrome are reported or potentially considered, such as ophthalmic viscoelastic device enriched by trypan blue, a pupil expansion device – Canabrava Ring, a femtosecond laser and a precision pulse capsulotomy. There is a current literature report showing a significant trend of decreasing occurrence of dropped nucleus of the lens into the vitreous body year by year in 2008–2018.
Based on the analysis of the available literature, it has been shown that pseudoexfoliation syndrome is an invariably important risk factor for cataract surgery, and it was also found that the reported trend can be explained by an increasingly deeper knowledge of pseudoexfoliation syndrome and the use of innovative techniques and improvement of the surgical workshop in cataract surgery complicated by this disease.
Keywords: pseudoexfoliation syndrome (PEX), cataract surgery, small pupil, zonular instability, intraoperative complications.
Słowa kluczowe: zespół pseudoeksfoliacji, operacja usunięcia zaćmy, wąska źrenica, osłabienie więzadełek obwódki rzęskowej, powikłania śródoperacyjne.