• What is pseudoexfoliation syndrome and should he have cataract surgery?


    My brother has cataracts. He was told he has exfoliation of the left eye and that a new lens might not heal properly and could have to be removed. Should he have the cataract in the left eye removed? What is exfoliation and can it be surgically corrected?


    Unless your brother is a glass blower, it is likely that he has pseudoexfoliation syndrome rather than exfoliation syndrome. It is absolutely true that cataract patients with pseudoexfoliation syndrome have a greater intraoperative and postoperative risk. One of the major concerns is that weakness in the zonule—which is the support structure for the lens and lens capsule—may lead to dislocation of the lens. There are techniques that can address this, both intraoperatively, if there appears to be weakness at the time of surgery, or postoperatively, if the lens dislocation happens later. Unfortunately, there is no way to surgically eliminate the existence of pseudoexfoliation, which is a systemic condition where microscopic protein fibers are shed from structures throughout the body, including the eye.

    The decision to have surgery is dependent upon the quality of vision, the severity of the cataract, and the risk-to-benefit ratio. I operate on patients with pseudoexfoliation every week, and usually their surgery goes very well.

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