Choice of operative time and method for pseudoexfoliation syndrome combined cataract with zonular defect

Background Pseudoexfoliation syndrome (PEX) is often complicated with cataract, accompanied by zonular defects.Zonular related complications easily happened intraoperatively and postoperatively.It is very important to choose the operating timing and method to reduce the complications and improve curative effects.However, relative study is rare. Objective This study was to analyze the curative effects of cataract extraction and intraocular lens (IOL) implantation for PEX combined cataract (PEXC) with zonular defect and discuss the appropriate operation timing and method. Methods A serial cases-observational study was performed, and written informed consent was obtained from each patient prior to ocular surgery.Twenty-three eyes of 21 patients with PEXC and zonular defect were included and received PEXC surgery inSecond People's Hospital of Kashi from July 2012 to December 2015.The patients were divided into phacodonesis type (18 eyes) and subluxation of lens (5 eyes) based on the severity of zonular defect and grade Ⅱ (4 eyes), grade Ⅲ (9 eyes), grade Ⅳ(7 eyes) and grade Ⅴ(3 eyes) nuclei based on the hardness of lens nuclei.Phacoemulsification combined capsular tension ring (CTR) or modified CTR (MCTR) insertion and IOL implantation was carried out for gradeⅡ and Ⅲ nuclei with phacodonesis eyes.or extracapsular cataract extraction combined CTR and IOL implantation was carried out for grade Ⅳ and Ⅴ nuclei with phacodonesis eyes, and phacoemulsification combined MCTR insertion and IOL implantation, or lens loop nucleus-deliver, anterior vitrectomy combined suspensory IOL implantation were performed for subluxation eyes.The patients were followed up for consecutive 3 months, and optimal operation timing, best corrected visual acuity (BCVA), intraocular pressure (IOP), complications and anterior capsular opening, IOL position were assessed. Results In the patients with phacodonesis, CTR was inserted in 10 eyes, and MCTR was inserted in 3 eyes, and extracapsular cataract extraction combined CTR and IOL implantation was carried out in 4 eyes and 1 eye received anterior vitrectomy combined suspensory IOL implantation.In the patient with subluxation of lens, only 1 eye finished successful phacoemulsification combined anterior vitrectomy and suspensory IOL implantation, and other 4 eyes received lens loop nucleus-deliver, anterior vitrectomy combined suspensory IOL implantation.The BCVA of the operated eyes was >0.5 in 4 eyes, >0.3-≤0.5 in 6 eyes, >0.1-≤0.3 in 8 eyes, ≤0.1 in 5 eyes, which was better than that before surgery (χ2=17.29, P 0.05). The intra- and post-operative complications included small pupil, corneal edema, residual cortex and posterior capsular opacification. Conclusions The operative process of PEXC eyes with zonular defect is complex.The choice of operative time and methods depends upon the type of zonular defect, hardness of lens nuleus, with or without subluxation of lens.A carefully ocular examination before operation is crucial for the therapy of PEXC. Key words: Pseudoexfoliation syndrome/complications; Cataract; Lens nucleus, crystalline/pathology; Zonular defect; Phacoemulsification; Lens implantation, intraocular; Operative time; Operative method; Capsular tension ring