Pseudoexfoliation: High risk factors for zonule weakness and concurrent vitrectomy during phacoemulsification

PURPOSE: To assess the frequency and results of cataract surgery with concurrent vitrectomy due to zonule weakness in eyes with pseudoexfoliation (PXF). SETTING: Private practice, Boston, Massachusetts, USA. METHODS: This retrospective nonrandomized study assessed consecutive eyes with PXF having cataract surgery. High risk was defined as preoperative phacodonesis, iridodonesis, or lens subluxation (subgroup 1); preoperative anterior chamber depth or angle-depth asymmetry between eyes confirmed by slitlamp biomicroscopy or gonioscopy, respectively (subgroup 2); or complicated cataract extraction related to zonule weakness in the fellow eye (subgroup 3). Exclusion criteria were previous vitrectomy, scleral buckle, or trabeculectomy surgery and combined cataract-glaucoma surgery. A comparative analysis of outcome parameters was performed. RESULTS: Of the 1059 eyes evaluated, 38 had vitrectomy. Concurrent vitrectomy was required in 19 (15.6%) of 122 high-risk eyes and 19 (2.0%) of 937 non-high-risk eyes (P<.00001). The need for concurrent vitrectomy was greatest in subgroup 3 (72.7%) and subgroup 1 (42.9%). There was no statistically significant difference between the vitrectomy group and the no-vitrectomy group in the mean improvement in logMAR corrected distance visual acuity (CDVA) (P = .38) or mean change in intraocular pressure (IOP) (mean decrease 2.6 mm Hg +/- 1.5 [SD] and 1.6 +/- 0.5 mm Hg, respectively) (P = .47). CONCLUSION: Despite the need for vitrectomy and the attendant increased demands in postoperative care, both the vitrectomy group and no-vitrectomy group had improved logMAR CDVA and IOP. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.