Complications of Phacoemulsification and Extracapsular Cataract Extraction Surgery in Eyes with Pseudoexfoliation Syndrome

Aim: To evaluate the complications of Phacoemulsification (PE) and Extracapsular Cataract Extraction (ECCE) surgery in eyes with Pseudoexfoliation Syndrome (PES).

Design: A retrospective study.

Methods: We retrospectively evaluated the charts of a total of 135 cataract cases with PES that had undergone PE (62) or ECCE (73) surgery. The intraoperative and postoperative complications of the cases with examination findings on the postoperative days 1, 7, 30, 90, and 180 were evaluated.

Results: The 135 cases consisted of 89 (65.92%) males and 46 (34.07%) females with a mean age of 69.78 ±7.84 (50-92) years. PE had been used as the surgical technique in 45.18% and ECCE in 54.81%. The rate of inadequate dilatation with mydriatics was 23.70% and the rate of iridophacodonesis was 7.40% preoperatively. The most common intraoperative complication was miosis (23.70%), followed by capsule rupture (9.62%). Intraoperative complications were statistically significantly more common in the ECCE group (p=0.002). The most common early postoperative complication was corneal edema (26.66%), followed by intraocular pressure (IOP) increase (14.81%) and fibrin reaction (8.88%). Early postoperative complications were statistically significantly more common in the ECCE group (p<0.001). In the postoperative late period, we observed posterior capsule opacification (PCO) in 4 cases (2.96%), capsular phimosis in one case (0.74%) and endothelial failure in 2 cases (1.48%). There was no significant difference between the two groups regarding postoperative late complications (p=0.594).

Conclusion: Pseudoexfoliation makes cataract surgery more difficult by causing inadequate mydriasis, zonular weakness and phacodonesis. Taking the complications into account, it can be said that PE is safer than ECCE for the cataract surgery of selected cases with PES. The high rate of ECCE complications in our study could be due to the higher miosis rates in these cases.