Zonular dialysis during extracapsular cataract extraction in pseudoexfoliation syndrome

Five patients with pseudoexfoliation syndrome (PES) and glaucoma developed extensive zonular dialyses during extracapsular cataract extractions. Weakness of the lens zonules or their attachments to the ciliary processes, which has been described in association with PES, may explain this complication. We believe that patients with PES are at particular risk for developing large zonular dialyses during extracapsular surgery. Preoperative phakodonesis, anterior chamber depth asymmetry, and excessive lens movement during the anterior capsulotomy should alert the surgeon to this problem.