Pseudoexfoliation with cataract – Frequency, clinical profile, and challenges during cataract surgery

Purpose: To study the frequency, clinical profile, surgical difficulties, and visual outcome in patients of pseudoexfoliation (PEX) scheduled for cataract surgery. Methods: A prospective, interventional, hospital-based study was conducted on 100 eyes from 100 patients of PEX syndrome consecutively undergoing manual small incision cataract surgery. All patients underwent complete ophthalmologic evaluation, that is, slit-lamp examination, tonometry, and ophthalmoscopy before the surgery. At the end of the surgical procedure, the intraoperative difficulties were noted. Postoperative follow-up at 1 week and 6 weeks was done to assess visual acuity. Result: We observed in our study that the mean age of patients with PEX was 73.2 ± 8.67. Fifty-seven patients had unilateral presentation, while 43 patients had bilateral presentation. The PXF material was distributed on the iris in 31% cases, followed by lens with 23% and pupillary margin with 11%. Hypermature cataract was the most commonly observed cataract with 41%. Intraoperative difficulties were reported in 39 cases, with poor pupillary dilation being the most common problem accounting for 20 cases. Conclusion: Cataract with PEX is a challenging scenario to operate upon, but good postoperative visual outcomes can be achieved with manual small incision cataract surgery by careful preoperative evaluation of risk factors and surgical plan, knowledge, and the ability to manage the complications.