A recent study aimed to compare anterior segment parameters post cataract surgery in eyes with pseudoexfoliation syndrome (PEX) and control eyes. The study conducted a prospective comparative analysis of 36 eyes in the PEX group, 16 eyes in the pseudoexfoliation glaucoma (PEXG) group, and 46 eyes in the control group, totaling 98 patients who underwent phacoemulsification with intraocular lens implantation. The evaluation, utilizing swept source anterior segment optical coherence tomography (AS-OCT), was conducted preoperatively, and at 1 week, 1 month, and 3 months postoperatively. Parameters including anterior chamber depth (ACD), angle opening distance (AOD500/750), trabecular-iris space area (TISA500/750), trabecular-iris angle (TIA500/750), and lens vault (LV) were assessed at each visit.
Before surgery, PEX and PEXG eyes exhibited significantly smaller ACD, AOD500/750, and TISA500/750, while LV was significantly greater compared to controls. However, 3 months postoperatively, all irido-corneal parameters and ACD increased significantly in all groups, with notable increases observed in the PEX group between 1 and 3 months post-surgery. The study found significantly greater relative increases in ACD, AOD500, TISA750, and TIA500/750 in PEX and PEXG groups compared to controls. These findings suggest that cataract surgery induces greater changes in anterior segment parameters in PEX and PEXG eyes than in control eyes, potentially impacting refractive outcomes and intraocular pressure control post-surgery.
PEX syndrome, identified by Lindberg in 1917, poses a risk factor for cataract, ocular hypertension, and open-angle glaucoma. Although PEX eyes typically have an open irido-corneal angle configuration, narrow angles are more prevalent in PEX eyes compared to the general population. PEX patients often experience a greater long-term decrease in intraocular pressure after cataract surgery, yet are susceptible to refractive surprises and worse refractive outcomes compared to healthy eyes. Additionally, spikes in intraocular pressure and glaucoma progression are common postoperative complications in PEX eyes.
Anterior segment optical coherence tomography (AS-OCT) provides an objective platform to visualize the anterior eye segment with high resolution, facilitating non-invasive quantitative analysis of anterior chamber morphology and irido-corneal angle. Previous ultrasound biomicroscopic (UBM) studies revealed abnormalities in the anterior segment of PEX eyes, such as zonular instability, lens thickening, shallow ACD, and narrow irido-corneal angles. AS-OCT offers a precise imaging technique for quantitative analysis, allowing for the comparison of cataract surgery outcomes between PEX and control eyes.
The study was conducted prospectively on 98 eyes of 98 patients who underwent uncomplicated phacoemulsification surgery with intraocular lens implantation. Follow-up occurred over 3 months, with evaluations at baseline, 1 week, 1 month, and 3 months post-surgery. AS-OCT was utilized to assess anterior segment parameters, including ACD, AOD500/750, TISA500/750, TIA500/750, and LV. Statistical analysis was performed using SPSS, with significance set at p < 0.05.
Overall, the study underscores the importance of understanding postoperative changes in anterior segment parameters in PEX and PEXG eyes compared to controls, potentially informing clinical management strategies for patients undergoing cataract surgery with pseudoexfoliation syndrome.
