Evaluation of changes in anterior segment parameters in patients with and without pseudoexfoliation syndrome after phacoemulsification

Session Details

Session Title: Presented Poster Session: Cataract Complications & Special Cases

Venue: Poster Village: Pod 1

First Author: : M.Dermenoudi GREECE

Co Author(s): :    A. Matsou   A. Tzamalis   E. Anastasopoulos                 

Abstract Details

Purpose:

Pseudoexfoliation syndrome (PEX) is typically characterized by the production and progressive deposition of distinctive abnormal fibrillar material in anterior segment structures (corneal epithelium and endothelium, anterior chamber angle, trabecular meshwork, lens). It is established as the most identifiable cause of secondary glaucoma (pseudoexfoliation glaucoma- PEXG) and has been implicated in surgical complications during phacoemulsification due to zonular weakness, poor intraoperative mydriasis and corneal endotheliopathy. The aim of this study is to quantitatively evaluate anterior chamber parameters and detect differences in their morphology in patients with pseudoexfoliation undergoing cataract surgery compared to a non-PEX control group.

Setting:

2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Greece

Methods:

Patients identified with PEX scheduled for cataract surgery, along with controls were prospectively enrolled over a 6-month period. All participants underwent ophthalmic examination, including best corrected visual acuity (BCVA), IOP, central corneal thickness (CCT), endothelial cell count (ECC), anterior chamber depth (ACD) and anterior chamber angle (ACA) measurements (angle opening space AOD500, AOD750 and trabecular iris space area TISA500, TISA750) by anterior segment OCT (AS-OCT, Visante, Carl Zeiss). Subjects were operated following the same phacoemulsification technique. Values were obtained at baseline and then at week 1, month 1 and month 3 after surgery. Cases with intra-operative complications were excluded.

Results:

44 PEX patients and 33 controls were consecutively enrolled. Demographic and baseline characteristics were similar except for age (p=0.0015) and pre-operative ECC (p=0.0319). No statistically significant difference was detected between groups in terms of pre-operative and post-operative BCVA, CCT, ECC loss, IOP, ACA, AOD500, AOD750, TISA500 and TISA750. Comparing the degree of alteration in anterior segment morphology, both groups showed equal extent of modification in; [DIF]ACA p=0.46, [DIF]AOD500 p=0.45, [DIF]AOD750 p=0.46, [DIF]TISA500 p=0.23, [DIF]TISA750 p=0.32. The only statistically significant difference was the post-op deepening of ACD, being more pronounced in PEX compared to controls (p=0.023).

Conclusions:

Most anterior segment parameters in patients with and without pseudoexfoliation shift significantly after cataract surgery. Modification of anterior chamber angle configuration after surgery, measured by AOD500, AOD750, TISA500 and TISA750, was similar in both groups indicating that post-operative angle opening is equivalent in eyes with and without pseudoexfoliation. ECC was lower in the PEX group compared to non-PEX at baseline, however, the amount of loss after surgery was comparable between the groups. Anterior chamber depth demonstrated a significant greater increase in PEX eyes after surgery, confirming that zonular weakness related with PEX plays an important role in post-operative capsular position.

Financial Disclosure:

None