Spontaneous, bilateral intraocular lens dislocation in a patient with exfoliation syndrome

Exfoliation syndrome (XFS) is a relatively common age-related disorder characterized by the production and progressive accumulation of a fibrillar extracellular material in numerous ocular tissues and throughout the body. XFS is a known identifiable cause of open-angle glaucoma. However, because of its widespread distribution, other structures in the eye are affected. Because of weakening of the zonular apparatus and posterior capsule, and subsequent loss of support for the lens or posterior chamber intraocular lenses (IOLs), its presence must be factored into the pre- and postoperative management of persons undergoing cataract surgery.

An 89-year-old white female presented with the sudden onset of decreased vision in her left eye. She had a history of uncomplicated cataract extraction and posterior chamber IOL implantation in each eye about 10 years previously. She was also known to have XFS. Examination found XFS, a dislocated posterior chamber IOL, anterior uveitis, and markedly elevated intraocular pressure. After stabilizing the eye medically, the patient presented 5 months later with the same condition in the right eye. This eye was also stabilized medically. The patient refused further treatment.

It is imperative that the comanaging optometrist and cataract surgeon be cognizant of the presence of XFS when planning cataract surgery. However, the effects of XFS may not be seen for many years after apparently successful cataract surgery.