Eyes with pseudoexfoliation are characterized by poor pupillary dilation and weakened zonular fibers. These findings increase the likelihood of intraoperative complications such as lens dislocation, capsular rupture, and vitreous loss. Safe cataract surgery in these eyes involves the same techniques as in eyes with advanced cataract and zonular dehiscence (discussed earlier in this chapter). Progressive capsular contraction, or capsular phimosis, is common in eyes with pseudoexfoliation. Dislocation of the implant into the vitreous is also possible. Careful consideration of the style and placement of the chosen lens implant is important. Capsular contraction is less likely with a 3-piece lens placed inside the capsular bag. If capsular phimosis occurs, a Nd:YAG laser may be used to create radial incisions in the anterior capsule to release tension on the zonular fibers and maintain the lens centrally.
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.