Outcomes of Cataract Surgery Complicated With Zonular Dialysis: A Multicenter Comparative Study

To compare the visual outcomes, rate of cystoid macular edema (CME), and additional associated complications in eyes that exhibited zonular dialysis (ZD) during phacoemulsification to a reference group of uneventful phacoemulsification eyes.

A retrospective multicenter comparative database study. We pooled data from 8 United Kingdom sites between 2003 and 2015. The main outcome measures were the mean postoperative visual acuity (VA) at 12-24 weeks and the rates of CME and additional associated complications.

We included 1074 eyes in the ZD group and 112,479 in the reference group. Logistic regression analysis showed that pseudoexfoliation was the strongest associated factor of ZD (OR: 6.1), followed by previous glaucoma surgery (OR: 4.4). Mean logMAR preoperative VA was 0.8 ± 0.6 in the ZD group vs. 0.6 ± 0.5 in the reference group (p < 0.001). Mean postoperative VA was worse in the ZD group (p < 0.001); 0.4 ± 0.6 vs. 0.2 ± 0.3 and 0.5 ± 0.6 vs. 0.2 ± 0.3 at 4-12 weeks and 12-24 weeks, respectively. At 12-24 weeks, the proportions of eyes that gained ≥0.3 logMAR units were 50% in the ZD group vs. 62% in the reference group (p < 0.001). In the ZD group, the most common intraoperative complication was vitreous loss (34.3%), followed by posterior capsular rupture (PCR) (11.1%). Postoperative CME occurred in 2.3% vs. 1.4% (p = 0.01), and 9.3% of eyes required surgery for correction of aphakia, intraocular lens decentration, or dropped lens figments removal.

The occurrence of ZD was associated with worse postoperative vision, an increased rate of vitreous loss and PCR, and a higher risk of CME.