Cataract surgery outcomes in pseudoexfoliation syndrome: a large multicenter database study

To evaluate intraoperative and postoperative complications and visual acuity (VA) outcomes of cataract surgery in pseudoexfoliation (PEX) eyes compared to non-PEX eyes.

We included eyes undergoing phacoemulsification across eight centers in the United Kingdom between July 2003 and March 2015. We categorized these into four groups based on the presence of PEX and other ocular comorbidities. Complications and VA were calculated among each group. Multivariable adjusted models were used to obtain adjusted differences in VA outcomes and adjusted relative risks (RR) of complications.

172,008 eyes were included. PEX was present in 1.2% of the study population. PEX eyes had more posterior capsular rupture, zonular dialysis, nucleus drop, and conversion to extracapsular extraction (adjusted RR = 2.3 [95% CI = 1.7 - 3.0], 6.7 [4.9 - 9.0], 2.5 [1.2 - 5.4], and 2.6 [1.03 - 6.3], respectively). Postoperatively, PEX eyes experienced more intraocular pressure ≥ 22 mmHg and IOL dislocation requiring surgical intervention (adjusted RR = 1.6 [1.1 - 2.3] and 7.3 [4.4 - 12.2], respectively). After accounting for the effect of ocular copathology, PEX eyes had similar postoperative VA outcomes (adjusted RR of achieving LogMAR <= 0.3 = 0.99, 95% CI = 0.95 - 1.02) and VA gain ≥ 0.3 logMAR (adjusted RR = 1.05, 95% CI = 0.99 - 1.11) at 4-12 weeks, compared to non-PEX eyes.

Cataract surgery in PEX has more intraoperative complications, but the visual outcomes were favorable. These findings can inform clinical decision-making and patient counseling in managing cataracts in individuals with PEX.