Inter-Eye Differences in Patients With Pseudoexfoliation Syndrome Presenting With IOL Dislocation
Narrative Responses:
Purpose
To analyze differences in glaucoma severity between eyes in patients with pseudoexfoliation (PXF) syndrome, who present with intraocular lens (IOL) dislocation.
Methods
Consecutive patients with histories of PXF and bilateral uneventful cataract surgery with in-the-bag IOLs, presenting with IOL dislocation (n=71), were retrospectively reviewed over a 5-year period. Fellow eyes were compared using McNemar’s test to assess the presence of glaucoma, and Wilcoxon signed rank tests to assess: preoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), optic nerve cup to disk ratio (C:D), mean deviation (MD) on visual field, retinal nerve fibre layer (RNFL) thickness, and glaucoma medication requirements. These parameters were also compared pre- and post-IOL exchange or repositioning surgery in the eye experiencing IOL dislocation.
Results
Seventy-one participants were included. Mean time between initial surgery and IOL exchange/repositioning was 8 years. The eye presenting with IOL dislocation was more likely to have glaucoma, or more severe glaucoma, than the fellow eye (p<0.0005). The affected eye also had worse mean CDVA (1.14 logMAR vs. 0.35 logMAR, p<0.0005), higher mean IOP (19 vs. 15, p<0.0005), greater mean number of glaucoma medication classes (1.4 vs. 0.5, p<0.0005), and worse MD and mean RNFL (MD -13.83 vs. -6.59 dB, p<0.0005; RNFL 69.2 vs. 82.4, p=0.001). In the affected eye, there were post-operative improvements in CDVA, IOP, and glaucoma medication requirements.
Conclusion
When comparing fellow eyes in patients with pseudoexfoliation syndrome, eyes presenting with IOL dislocation were more likely to be associated with the presence of glaucoma, and of greater severity.