Abstract

Dr. Soniya Upase*, Ret. Dr. (Col) S. K. Srivastava, Dr. Rajashree Bane, Dr. Arundhati Pande

ABSTRACT

Background: Pseudoexfoliation (PXF) syndrome is an age-related common condition characterized by deposition of fibrillar material on ocular structures, leading to increased surgical challenges during cataract extraction surgery. This study aimed to compare preoperative and intraoperative surgical challenges in senile cataract cases with and without pseudoexfoliation. Methods: A prospective comparative study was conducted on 180 patients, including 90 with senile PXF cataract and 90 with senile cataract without PXF. Preoperative assessment included slit- lamp examination, evaluation of pseudoexfoliative material, pupillary dilation, intraocular pressure, lens status, pre-existing zonular dialysis, glaucoma evaluation, fundus examination. All cases underwent standard phacoemulsification or small-incision cataract surgery (SICS) under similar surgical settings. Intraoperative parameters such as poor pupillary dilation, zonular weakness, phacodonesis, capsular rupture, vitreous loss, and intraocular lens (IOL) implantation difficulties were recorded and compared. Results: Intraoperative complications were more frequent in the PXF group. Poor pupillary dilation (p<0.0001) and zonular dialysis (p<0.0001), Interventions for small pupil more frequent in cases with PXF (P<0.0001), Intraocular pressure (<0.001) were significantly higher in PXF eyes. Chi square test was applied as a test of significance. Capsular rupture and vitreous loss occurred more often in PXF cases than in the non-PXF group. Conclusion: Senile cataract cases with pseudoexfoliation present greater intraoperative challenges due to poor pupillary dilation and zonular dialysis, raised intraocular pressure. Meticulous preoperative evaluation, well planned surgical approach, and availability of intraoperative aids are essential to minimize complications and achieve optimal surgical outcomes.