• Written By: Commentary by Darrell WuDunn, MD, PhD
    Cataract/Anterior Segment, Glaucoma

    This analysis of spontaneous IOL dislocation in patients with pseudoexfoliation syndrome (PXF) shows that eyes with glaucoma, particularly those with severe disease, are more likely to experience IOL dislocation. 

    The main strength of this study was the use of fellow eyes as case-controls for eyes presenting with IOL dislocation in patients with PXF, minimizing confounding factors that could influence glaucoma severity and risk of IOL dislocation. 

    Researchers identified 71 patients who had undergone uneventful cataract surgery with an in-the-bag IOL and later experienced IOL dislocation. Indicators of glaucoma severity were compared between fellow eyes as well as before and after IOL exchange or repositioning in the affected eyes. 

    The authors found that IOL dislocation was more likely to occur in eyes with glaucoma (P< 0.0001), particularly in those with severe disease (P< 0.0001). Affected eyes also had worse mean CDVA and higher mean IOP, and were treated with a greater mean number of glaucoma medications. 

    These results may be due to more advanced pseudoexfoliation pathology, such as increased deposition of the fibillar material throughout the eye, which increases the risk of both glaucoma and a weakening of lens zonules. The average time between the initial cataract surgery (primarily phacoemulsification) and IOL dislocation surgery was 7.7 years. However, it’s unclear if fellow eyes were as far out from their cataract surgeries. It is possible that a major risk for IOL dislocation is time, since cataract surgery and the initial cataract surgery is associated with glaucoma and glaucoma severity. 

    Regardless, this study provides some important findings that have real clinical significance for managing patients with pseudoexfoliation syndrome.