Pseudoexfoliation syndrome: clinical factors related to capsular rupture in cataract surgery

Extracapsular surgery has a high frequency of capsular rupture or disinsertion in patients with pseudoexfoliation syndrome. Irido-phakodonesis is one of the factors that suggests this complication. Irido-phakodonesis acts as an 'all or nothing' mechanism, as it does not appear until there is a certain degree of zonular lesion. We carried out a study on 330 eyes with pseudoexfoliation, relating irido-phakodonesis to 31 clinical signs. The results showed that irido-phakodonesis is related to cataracts, degree of mydriasis, presence of glaucoma, atrophy of the pupilar pigmentary ruff, and uniform pigmentation of the trabecular meshwork. These results suggest that the signs which indicate the existence of zonular lesion during extracapsular surgery, include poor dilation, the presence of glaucoma and pigmentary alterations, whilst the pseudoexfoliation material deposited in the anterior segment does not appear to have a bearing on this complication.