Pseudoexfoliation is a ubiquitous syndrome of multifactorial origin affecting elderly people by increasing the risk of cataract and secondary glaucoma development. Despite modern techniques and technologies for cataract surgery, pseudoexfoliation syndrome represents a challenge for surgeons because of the increased weakness of the zonular apparatus and limited pupil dilation. Due to the inherent difficulties during surgery, the risk of vitreous loss in these patients is several times higher than in cataract patients without pseudoexfoliation. Using currently available surgical devices (ophthalmic viscosurgical device, iris retractors and ring dilators, capsular tension ring, etc.), the risk of intraoperative complications may be much reduced, allowing the surgeon to handle difficult cases with greater confidence and safety. This review analyzes the methodologic approach to the patient with zonular laxity with the aim of providing useful advices to limit the risks of intraoperative and postoperative complications. From the preoperative planning, to the intraoperative management of the small pupil and phacodonesis, and to the postoperative correction of capsule phimosis and intraocular lens dislocation, a step approach to the surgical management of pseudoexfoliation patients is illustrated.

/pdf/cataract-surgery-in-patients-with-pseudoexfoliation-syndrome-24f7qrtj85.pdf

Cataract surgery in patients with pseudoexfoliation syndrome: current updates

Purpose To compare corneal endothelial cell damage and ocular inflammation after cataract surgery in eyes with and without pseudoexfoliation (PXF). Setting Hayashi Eye Hospital, Fukuoka, Japan. Design Nonrandomized comparative study. Methods This study comprised eyes with PXF (PXF group) and age-matched eyes without PXF (non-PXF group) scheduled for phacoemulsification. Preoperatively and 1 and 3 months postoperatively, corneal endothelial cell density (ECD) and central corneal thickness (CCT) were measured using a specular microscope. Flare intensity was measured using a flare meter, and central macular thickness was measured using optical coherence tomography. Results Each group had 36 eyes. The mean ECD was significantly lower in the PXF group than in the non-PXF group preoperatively and postoperatively (P≤.0250). The percentage of endothelial cell loss was significantly greater in the PXF group than in the non-PXF group (P≤.0216); the percentage was 9.0% in the PXF group and 3.4% in the non-PXF group 3 months postoperatively. The mean CCT was similar between groups throughout the follow-up period; however, the percentage increase in CCT was significantly greater in the PXF group than in the non-PXF group 1 month postoperatively (P=.0152). Flare intensity and foveal thickness did not differ significantly between groups throughout the follow-up period (P≥.3079). Conclusions Corneal endothelial cell loss and a transient increase in CCT were greater after cataract surgery in eyes with PXF than in eyes without PXF. Thus, because the corneal endothelium in eyes with PXF is vulnerable to cataract surgery, careful surgical procedures are necessary. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Corneal endothelial damage after cataract surgery in eyes with pseudoexfoliation syndrome

Objectives:The effects of smoking on central corneal thickness (CCT), corneal endothelial cell density (ECD), and morphology were evaluated in otherwise healthy subjects.Methods:The study included 103 current smokers and 106 healthy nonsmoking subjects without any eye disease apart from refractive e

Effects of Smoking on Central Corneal Thickness and the Corneal Endothelial Cell Layer in Otherwise Healthy Subjects.

Purpose: To quantify the morphological alterations in corneal nerve fibers and cells in patients with pseudoexfoliation syndrome (PEX) and their relationship with the presence of hyperreflective endothelial deposits observed using in vivo confocal microscopy. Methods: One eye each of 37 patients with PEX and 20 age-matched healthy control subjects was evaluated by in vivo corneal confocal microscopy. Patients with PEX were further classified into two groups: those with and without hyperreflective endothelial deposits. We evaluated the densities of basal epithelial cells, anterior and posterior stromal keratocytes, and endothelial cells and structure of sub-basal nerve fibers. Results: The mean anterior and posterior stromal keratocyte and endothelial cell densities and corneal sub-basal nerve plexus variables were significantly lower in patients with PEX compared with those in healthy control subjects. The mean basal epithelial cell density did not significantly differ. Conclusion: Eyes with PEX presented decreased corneal sub-basal nerve plexus variables and cell densities in all corneas, except for the mean basal epithelial cell density. Further, a trend of lower corneal sub-basal nerve plexus measurements in patients with hyperreflective endothelial deposits compared with those without endothelial deposits was observed.

/pdf/characteristics-of-the-cornea-in-patients-with-4ndoxevg7s.pdf

Characteristics of the cornea in patients with pseudoexfoliation syndrome.

Morphometric changes of corneal endothelial cells in pseudoexfoliation syndrome and pseudoexfoliation glaucoma

Background: The characteristics of the corneal endothelium in patients with/without pseudoexfoliation syndrome (PEX) with senile cataract in Paraguay are unknown.



Methods:  Endothelial density, mean coefficient of variation (%) in cell size and mean cell hexagonality (%) were measured using automated specular microscopy. Multivariate general linear model analysis was used to determine the effect of age, gender and PEX on endothelial characteristics. Analysis of variance tests analysed the effect of age on endothelial variables without regard to PEX status. Categories of <2000 and ≥2000 cells/mm2 were compared in the presence/absence of PEX using age as covariate to calculate odds ratios for corneal decompensation.



Results:  Out of 468 eligible patients, 51 were excluded. Sixty-one patients had PEX. Unadjusted mean endothelial cell density was 2451 cells/mm2; cell size coefficient of variation was 34.3; and the mean percentage of hexagonal cells was 57.7. Adjusting for age, only the mean difference between the groups with and without PEX for endothelial cell density was significant (PEX = 2315, no PEX = 2482, P = 0.002). Of the total study population, at-risk endothelial cell densities were found in 46 eyes (11%); and 13 (28%) of those were found to have PEX. When PEX was present, the calculated odds ratio for corneal decompensation following surgery was 1.90 after adjustment for age.



Conclusions:  Endothelial cell density data were consistent with published literature. Because Paraguay has a high prevalent of PEX, it is suggested that specular microscopy screening be carried out for all patients scheduled for intraocular surgery where feasible.

Characteristics of the corneal endothelium and pseudoexfoliation syndrome in patients with senile cataract

/pdf/microbial-contamination-of-eye-drops-used-by-patients-in-an-4enxrutisz.pdf

Microbial contamination of eye drops used by patients in an outpatient clinic of ophthalmology

Los colirios contaminados representan una causa potencial de infeccion ocular prevenible. Como toda medicacion terapeutica topica, los colirios deben estar libres de agentes contaminantes. La frecuencia de contaminacion varia entre 0,07% y 35,6% en los estudios publicados; no existiendo estudios publicados sobre este tema en nuestro pais. Este estudio tiene como objetivo determinar la frecuencia de contaminacion de las gotas oftalmicas utilizadas por pacientes que consultan en la Fundacion Vision en Asuncion, Paraguay. A todos los pacientes que acudieron a la consulta externa en el Servicio de Oftalmologia de la Fundacion Vision, de agosto de 2007 a julio de 2008 se les solicito que entregaran sus envases de gotas oftalmicas que estuvieron utilizando por dos o mas semanas, ademas se registraron sus datos demograficos y relacionados al uso del colirio. Los envases fueron enviados al Instituto de Investigaciones en Ciencias de la Salud (IICS), de manera que la medicacion restante en el interior de los mismos fuera cultivada en los medios microbiologicos convencionales. De los 73 envases recolectados, 8 (11%) presentaron cultivos positivos, siendo los germenes aislados Estafilococo coagulasa negativo, Propionibacterium acnes, Serratia marcescens, Corynebacterium sp y Alcaligenes faecalis, ademas del hongo oportunista Aspergillus fumigatus. La contaminacion de los colirios utilizados por estos pacientes es relevante. Estos resultados coinciden con reportes de otros paises y senala la importancia de dar orientaciones a los pacientes en cuanto al modo de utilizacion, almacenamiento y tiempo de recambio de los colirios por parte de los oftalmologos.

Contaminación microbiana de colirios utilizados por pacientes en la consulta externa de oftalmología

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Characteristics of the corneal endothelium and pseudoexfoliation syndrome in patients with senile cataract

Microbial contamination of eye drops used by patients in an outpatient clinic of ophthalmology

Contaminación microbiana de colirios utilizados por pacientes en la consulta externa de oftalmología