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Complications and visual outcomes of cataract surgery in patients with pseudoexfoliation

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Abstract

Purpose

To compare outcomes of cataract surgery performed by ophthalmic trainees and consultants in patients associated with pseudoexfoliation (PXF)

Methods

Retrospective review of medical records of all patients with PXF who had undergone cataract surgery from January 2016 to December 2018 at L V Prasad Eye Institute, Hyderabad, India, were analysed

Results

A total of 914 eyes were included in the study; surgeries on 501 (54.8%) eyes with PXF were performed by trainees, while 413 (45.2%) were performed by consultants. Posterior capsule rupture (PCR) with vitreous loss (VL) occurred in significantly fewer eyes operated on by consultants (n = 8, 1.9%) than those operated on by trainees (n = 23, 4.5%) (p = 0.002). Eyes that underwent small incision cataract surgery (n = 100, 21.2%) had a significantly greater number of complications than those that underwent phacoemulsification (n = 31, 7.1%) (p = 0.00001). Multivariate logistic regression analysis shows that chances of a complication are higher when operated on by a trainee (OR = 1.59, 95% CI: 1.09–2.34, p = 0.02).The mean logMAR corrected distance visual acuity of patients one month post-surgery was significantly higher for patients in the consultant group (0.15 ± 0.3) than for those in the trainee group (0.2 ± 0.4) (p = 0.003).

Conclusion

Patients with PXF operated on by trainees for cataract had a relatively higher risk of developing PCR with VL and had poorer visual outcomes than those operated on by consultants.

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Availability of data and material

All authors had access to the data documented in the electronic medical records.

References

  1. Ritch R, Schlötzer-Schrehardt U (2001) Exfoliation syndrome. Surv Ophthalmol 45:265–315. https://doi.org/10.1016/s0039-6257(00)00196

    Article  CAS  PubMed  Google Scholar 

  2. Arvind H, Raju P, Paul PG, Baskaran M, Ramesh SV, George RJ, McCarty C, Vijaya L (2003) Pseudoexfoliation in South India. Br J Ophthalmol 87:1321–1323. https://doi.org/10.1136/bjo.87.11.1321

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Young AL, Tang WW, Lam DS (2004) The prevalence of pseudoexfoliation syndrome in Chinese people. Br J Ophthalmol 88:193–195. https://doi.org/10.1136/bjo.2003.021816

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Kaljurand K, Puska P (2004) Exfoliation syndrome in Estonian patients scheduled for cataract surgery. Acta Ophthalmol Scand 82:259–263. https://doi.org/10.1111/j.1600-0420.2004.00256

    Article  PubMed  Google Scholar 

  5. Sangal N, Chen TC (2014) Cataract surgery in pseudoexfoliation syndrome. Seminars Ophthalmol 29:403–408. https://doi.org/10.3109/08820538.2014.959189

    Article  Google Scholar 

  6. Schlötzer-Schrehardt U, Naumann GO (1994) A histopathologic study of zonular instability in pseudoexfoliation syndrome. Am J Ophthalmol 118:730–743. https://doi.org/10.1016/s0002-9394(14)72552-8

    Article  PubMed  Google Scholar 

  7. Shingleton BJ, Crandall AS, Ahmed II (2009) Pseudoexfoliation and the cataract surgeon: preoperative, intraoperative, and postoperative issues related to intraocular pressure, cataract, and intraocular lenses. J Cataract Refract Surg 35:1101–1120. https://doi.org/10.1016/j.jcrs.2009.03.011

    Article  PubMed  Google Scholar 

  8. Nagashima R. J. (2004). Decreased incidence of capsule complications and vitreous loss during phacoemulsification in eyes with pseudoexfoliation syndrome. J Cataract Refract Surg 30:127–131. https://doi.org/10.1016/S0886-3350(03)00465-6

  9. Hyams M, Mathalone N, Herskovitz M, Hod Y, Israeli D, Geyer O (2005) Intraoperative complications of phacoemulsification in eyes with and without pseudoexfoliation. J Cataract Refract Surg 31:1002–1005. https://doi.org/10.1016/j.jcrs.2004.09.051

    Article  PubMed  Google Scholar 

  10. Shastri L, Vasavada A (2001) Phacoemulsification in Indian eyes with pseudoexfoliation syndrome. J Cataract Refract Surg 27:1629–1637. https://doi.org/10.1016/s0886-3350(01)00960-9

    Article  CAS  PubMed  Google Scholar 

  11. Chylack LT Jr, Wolfe JK, Singer DM, Leske MC, Bullimore MA, Bailey IL, Friend J, McCarthy D, Wu SY (1993) The lens opacities classification system III. The Longitudinal Study of Cataract Study Group. Arch Ophthalmol (Chicago, Ill: 1960) 111:831–836. https://doi.org/10.1001/archopht.1993.01090060119035

  12. Liu XW, Wang Z, Yu WH, Wang ZW, Zhang YN, Liu JJ, Sui RF (2011) Idiopathic phacodonesis in senile cataract patients in Qinghai, China. Int J Ophthalmol 4:508–512. https://doi.org/10.3980/j.issn.2222-3959.2011.05.10

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sood NN (1968) Prevalence of pseudoexfoliation of the lens capsule in India. Acta Ophthalmol 46:211–214. https://doi.org/10.1111/j.1755-3768.1968.tb05179

    Article  CAS  Google Scholar 

  14. Thomas R, Nirmalan PK, Krishnaiah S (2005) Pseudoexfoliation in southern India: the Andhra Pradesh Eye Disease Study. Invest Ophthalmol Vis Sci 46:1170–1176. https://doi.org/10.1167/iovs.04-1062

    Article  PubMed  Google Scholar 

  15. Joshi RS, Singanwad SV (2019) Frequency and surgical difficulties associated with pseudoexfoliation syndrome among Indian rural population scheduled for cataract surgery: Hospital-based data. Indian J Ophthalmol 67:221–226. https://doi.org/10.4103/ijo.IJO_931_18

    Article  PubMed  PubMed Central  Google Scholar 

  16. Miyazaki M, Kubota T, Kubo M, Kiyohara Y, Iida M, Nose Y, Ishibashi T (2005) The prevalence of pseudoexfoliation syndrome in a Japanese population: the Hisayama study. J Glaucoma 14:482–484. https://doi.org/10.1097/01.ijg.0000185436.15675.b3

    Article  PubMed  Google Scholar 

  17. Mccarty CA, Taylor HR (2000) Pseudoexfoliation syndrome in Australian adults. Am J Ophthalmol 129:629–633. https://doi.org/10.1016/s0002-9394(99)00466-3

    Article  CAS  PubMed  Google Scholar 

  18. Sufi AR, Singh T, Mufti AA, Rather MH (2012) Outcome of phacoemulsification in patients with and without Pseudoexfoliation syndrome in Kashmir. BMC Ophthalmol 12:13. https://doi.org/10.1186/1471-2415-12-13

    Article  PubMed  PubMed Central  Google Scholar 

  19. Naik AU, Gadewar SB (2017) Visual outcome of phacoemulsification versus small incision cataract surgery in Pseudoexfoliation syndrome—a pilot study. J Clin Diagn Res JCDR 11(1):NC05–NC08. https://doi.org/10.7860/JCDR/2017/22207.9311

  20. Avramides S, Traianidis P, Sakkias G (1997) Cataract surgery and lens implantation in eyes with exfoliation syndrome. J Cataract Refract Surg 23:583–587. https://doi.org/10.1016/s0886-3350(97)80219-2

    Article  CAS  PubMed  Google Scholar 

  21. Arnarsson A, Damji KF, Sverrisson T, Sasaki H, Jonasson F (2007) Pseudoexfoliation in the Reykjavik Eye Study: prevalence and related ophthalmological variables. Acta Ophthalmol Scand 85(8):822–827. https://doi.org/10.1111/j.1600-0420.2007.01051

    Article  PubMed  Google Scholar 

  22. Shingleton BJ, Marvin AC, Heier JS, O’Donoghue MW, Laul A, Wolff B, Rowland A (2010) Pseudoexfoliation: high risk factors for zonule weakness and concurrent vitrectomy during phacoemulsification. J Cataract Refract Surg 36:1261–1269. https://doi.org/10.1016/j.jcrs.2010.02.014

    Article  PubMed  Google Scholar 

  23. Alfaiate M, Leite E, Mira J, Cunha-Vaz JG (1996) Prevalence and surgical complications of pseudoexfoliation syndrome in Portuguese patients with senile cataract. J Cataract Refract Surg 22:972–976. https://doi.org/10.1016/s0886-3350(96)80202-1

    Article  CAS  PubMed  Google Scholar 

  24. Scorolli L, Scorolli L, Campos EC, Bassein L, Meduri RA (1998) Pseudoexfoliation syndrome: a cohort study on intraoperative complications in cataract surgery. Ophthalmol J Int d'ophtalmol Int J Ophthalmol Zeitschrift fur Augenheilkunde 212:278–280. https://doi.org/10.1159/000027307

    Article  CAS  Google Scholar 

  25. Hemalatha BC, Shetty SB (2016) Analysis of intraoperative and postoperative complications in pseudoexfoliation eyes undergoing cataract surgery. J Clin Diagn Res JCDR 10:NC05–NC8. https://doi.org/10.7860/JCDR/2016/17548.7545

  26. Shingleton BJ, Heltzer J, O’Donoghue MW (2003) Outcomes of phacoemulsification in patients with and without pseudoexfoliation syndrome. J Cataract Refract Surg 29:1080–1086. https://doi.org/10.1016/s0886-3350(02)01993-4

    Article  PubMed  Google Scholar 

  27. Katsimpris JM, Petropoulos IK, Apostolakis K, Feretis D (2004) Comparing phacoemulsification and extracapsular cataract extraction in eyes with pseudoexfoliation syndrome, small pupil, and phacodonesis. Klin Monatsbl Augenheilkd 221:328–333. https://doi.org/10.1055/s-2004-812863

    Article  CAS  PubMed  Google Scholar 

  28. Drolsum L, Haaskjold E, Sandvig K (1998) Phacoemulsification in eyes with pseudoexfoliation. J Cataract Refract Surg 24:787–792. https://doi.org/10.1016/s0886-3350(98)80132-6

    Article  CAS  PubMed  Google Scholar 

  29. Kim BZ, Patel DV, Sherwin T, McGhee CN (2016) The Auckland Cataract Study: assessing preoperative risk stratification systems for phacoemulsification surgery in a teaching hospital. Am J Ophthalmol 171:145–150. https://doi.org/10.1016/j.ajo.2016.09.003

    Article  PubMed  Google Scholar 

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Funding

Funding for this study was provided by the Hyderabad Eye Research Foundation, L V Prasad Eye Institute, India.

Author information

Authors and Affiliations

  1. Cataract & Refractive Surgery Services, L V Prasad Eye Institute, Hyderabad, India

    Vivek M. Singh, Revathy Yerramneni, Tanvi Madia, Pravin K. Vaddavalli & Jagadesh C. Reddy

  2. Cornea Institute, L V Prasad Eye Institute, Hyderabad, India

    Sai Prashanthi, Pravin K. Vaddavalli & Jagadesh C. Reddy

  3. Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, India

    Jagadesh C. Reddy

Authors
  1. Vivek M. Singh
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  2. Revathy Yerramneni
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  3. Tanvi Madia
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  5. Pravin K. Vaddavalli
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  6. Jagadesh C. Reddy
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Corresponding author

Correspondence to Jagadesh C. Reddy.

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This study was approved by the Institutional review board (No. 07-17-063).

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Singh, V.M., Yerramneni, R., Madia, T. et al. Complications and visual outcomes of cataract surgery in patients with pseudoexfoliation. Int Ophthalmol 41, 2303–2314 (2021). https://doi.org/10.1007/s10792-021-01752-x

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  • DOI: https://doi.org/10.1007/s10792-021-01752-x

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