Intraocular Pressure in Eyes with Intraocular Lens Dislocation and Pseudoexfoliation Syndrome

Abstract

Purpose To investigate intraocular pressure in eyes with intraocular lens subluxation and pseudoexfoliation syndrome.

Methods In this retrospective study conducted at one eye centre (tazz) in Zurich, Switzerland, we reviewed 85 eyes with intraocular lens subluxation and pseudoexfoliation syndrome. Intraocular lens exchange was carried out by two surgeons between 03/2016 and 12/2019 (45 months). Information on baseline characteristics and diagnosis of glaucoma was recorded. Intraocular pressure and best-corrected visual acuity were analysed preoperatively and at five time points up to 12 months after lens exchange. Data on antiglaucomatous medication was collected before surgery and at two different time points after surgery. Postoperative pressure lowering procedures and complications were further analysed.

Results This study includes 85 pseudoexfoliation eyes with intraocular lens subluxation. The mean interval between cataract surgery and lens exchange was 8.9 ± 5.2 years. Intraocular pressure elevation in the event of intraocular lens subluxation was found in 54% (46/85) of eyes. Mean intraocular pressure decreased from 22.9 ± 9.4 mmHg preoperatively to 15.2 ± 3.4 mmHg at follow-up 12 months after lens exchange (p < 0.001). Postoperative topical antiglaucomatous drug requirements were comparable to preoperative levels (p = 0.520). Less systemic acetazolamide was required 12 months postoperatively (p = 0.018). A pressure lowering procedure was required in seven (8%) eyes in the postoperative period due to persistence of high intraocular pressure. Intermittent increase or persistence of high intraocular pressure occurred in 13 (15%) eyes.

Conclusion This study emphasises the connection between acute pressure elevation and intraocular lens subluxation in patients with pseudoexfoliation syndrome. Intraocular pressure decreases after lens exchange and decrease sustains for a postoperative period of 12 months. Postoperative pressure lowering procedures were not required in the majority of eyes. We therefore conclude that intraocular lens exchange is efficient in the management of lens subluxation and pressure elevation in patients with pseudoexfoliation syndrome.

Zusammenfassung

Hintergrund Der Intraokulardruck wird bei einer Subluxation der Intraokularlinsen in Augen mit Pseudoexfoliationssyndrom (PEX) untersucht.

Methodik Diese retrospektive Studie, durchgeführt am Talacker Augen Zentrum Zürich, untersucht 85 Augen mit Subluxation der Intraokularlinse und Pseudoexfoliationssyndrom. Der Wechsel der Intraokularlinse wurde durch 2 Chirurgen zwischen 03/2016 und 12/2019 durchgeführt (45 Monate). Informationen zu Baseline-Charakteristika und Glaukomdiagnose wurden gesammelt. Intraokulardruck und bestkorrigierter Fernvisus wurden präoperativ und zu 5 unterschiedlichen Zeitpunkten bis 12 Monate nach Linsenwechsel untersucht. Die drucksenkende Medikation wurde präoperativ, 6 Monate und 12 Monate postoperativ untersucht. Postoperative Komplikationen und drucksenkende Operationen wurden analysiert.

Resultate In diese Studie wurden 85 Augen eingeschlossen. Das durchschnittliche Intervall zwischen Kataraktoperation und Linsenwechsel betrug 8,9 ± 5,2 Jahre. Ein Intraokulardruckanstieg bei Subluxation der Intraokularlinse wurde in 54% (46/85) der PEX-Augen beobachtet. Der durchschnittliche Intraokulardruck sank von präoperativ 22,9 ± 9,4 mmHg auf 15,2 ± 3,4 mmHg 12 Monate nach Linsenwechsel (p < 0,001). Die topische Therapie zur Drucksenkung war prä- und postoperativ vergleichbar (p = 0,520). Es wurde postoperativ weniger systemische Therapie zur Druckkontrolle appliziert (p = 0,018). Eine drucksenkende Operation wurde im postoperativen Intervall in 7 Augen (8%) aufgrund der anhaltend hohen Intraokulardruckwerte notwendig. Ein wiederkehrender oder persistierender Druckanstieg trat postoperativ in 13 (15%) Augen auf.

Schlussfolgerung Diese Studie unterstreicht den Zusammenhang zwischen akutem Druckanstieg und Subluxation der Intraokularlinse bei Patienten mit Pseudoexfoliationssyndrom. Die Intraokulardruckkontrolle kann durch einen Linsenwechsel erzielt werden und bleibt bis 12 Monate postoperativ erhalten. Eine drucksenkende Operation wird im postoperativen Intervall nur in einer geringen Anzahl Augen notwendig. Aus diesem Grund schlussfolgern wir, dass der Linsenwechsel eine Intraokulardruckkontrolle bei Pseudoexfoliationssyndrom und Linsensubluxation ermöglicht.

Key words

glaucoma - pseudoexfoliation syndrome - lens exchange - dislocation

Schlüsselwörter

Glaukom - Pseudoexfoliationssyndrom - Intraokularlinse - Subluxation - Linsenwechsel

Publication History

Received: 08 October 2021

Accepted: 06 February 2022

Article published online:
26 April 2022

• References

• 1 Ritch R. Exfoliation syndrome. Curr Opin Ophthalmol 2001; 12: 124-130 DOI: 10.1097/00055735-200104000-00008.
• 2 Schlötzer-Schrehardt U, Naumann GO. Ocular and systemic pseudoexfoliation syndrome. Am J Ophthalmol 2006; 141: 921-937 DOI: 10.1016/j.ajo.2006.01.047.
• 3 Shingleton BJ, Marvin AC, Heier JS. et al. Pseudoexfoliation: High risk factors for zonule weakness and concurrent vitrectomy during phacoemulsification. J Cataract Refract Surg 2010; 36: 1261-1269 DOI: 10.1016/j.jcrs.2010.02.014.
• 4 Sein J, Galor A, Sheth A. et al. Exfoliation syndrome: new genetic and pathophysiologic insights. Curr Opin Ophthalmol 2013; 24: 167-174 DOI: 10.1097/ICU.0b013e32835d5d11.
• 5 Schlötzer-Schrehardt U, Naumann GO. A histopathologic study of zonular instability in pseudoexfoliation syndrome. Am J Ophthalmol 1994; 118: 730-743 DOI: 10.1016/s0002-9394(14)72552-8.
• 6 Kristianslund O, Raen M, Ostern AE. et al. Late In-the-Bag Intraocular Lens Dislocation: A Randomized Clinical Trial Comparing Lens Repositioning and Lens Exchange. Ophthalmology 2017; 124: 151-159 DOI: 10.1016/j.ophtha.2016.10.024.
• 7 Lorente R, de Rojas V, Vazquez de Parga P. et al. Management of late spontaneous in-the-bag intraocular lens dislocation: Retrospective analysis of 45 cases. J Cataract Refract Surg 2010; 36: 1270-1282 DOI: 10.1016/j.jcrs.2010.01.035.
• 8 Shingleton BJ, Yang Y, OʼDonoghue MW. Management and outcomes of intraocular lens dislocation in patients with pseudoexfoliation. J Cataract Refract Surg 2013; 39: 984-993 DOI: 10.1016/j.jcrs.2013.01.044.
• 9 Jehan FS, Mamalis N, Crandall AS. Spontaneous late dislocation of intraocular lens within the capsular bag in pseudoexfoliation patients. Ophthalmology 2001; 108: 1727-1731
• 10 Gross JG, Kokame GT, Weinberg DV. et al. In-the-bag intraocular lens dislocation. Am J Ophthalmol 2004; 137: 630-635 DOI: 10.1016/j.ajo.2003.10.037.
• 11 Hayashi K, Hirata A, Hayashi H. Possible predisposing factors for in-the-bag and out-of-the-bag intraocular lens dislocation and outcomes of intraocular lens exchange surgery. Ophthalmology 2007; 114: 969-975 DOI: 10.1016/j.ophtha.2006.09.017.
• 12 Kim SS, Smiddy WE, Feuer W. et al. Management of dislocated intraocular lenses. Ophthalmology 2008; 115: 1699-1704 DOI: 10.1016/j.ophtha.2008.04.016.
• 13 Davis D, Brubaker J, Espandar L. et al. Late in-the-bag spontaneous intraocular lens dislocation: evaluation of 86 consecutive cases. Ophthalmology 2009; 116: 664-670 DOI: 10.1016/j.ophtha.2008.11.018.
• 14 Jakobsson G, Zetterberg M, Sundelin K. et al. Surgical repositioning of intraocular lenses after late dislocation: complications, effect on intraocular pressure, and visual outcomes. J Cataract Refract Surg 2013; 39: 1879-1885 DOI: 10.1016/j.jcrs.2013.06.023.
• 15 Ostern AE, Sandvik GF, Drolsum L. Late in-the-bag intraocular lens dislocation in eyes with pseudoexfoliation syndrome. Acta Ophthalmol 2014; 92: 184-191 DOI: 10.1111/aos.12024.
• 16 Leung VC, Singh H, Ahmed II. Inter-eye differences in patients with pseudoexfoliation syndrome presenting with intraocular lens dislocation. Ophthalmology 2015; 122: 480-485 DOI: 10.1016/j.ophtha.2014.09.003.
• 17 Ozaki M. Mechanisms of Glaucoma in Exfoliation Syndrome. J Glaucoma 2018; 27 (Suppl. 01) S83-S86 DOI: 10.1097/IJG.0000000000000906.
• 18 Jakobsson G, Zetterberg M, Lundström M. et al. Late dislocation of in-the-bag and out-of-the bag intraocular lenses: ocular and surgical characteristics and time to lens repositioning. J Cataract Refract Surg 2010; 36: 1637-1644 DOI: 10.1016/j.jcrs.2010.04.042.
• 19 Kristianslund O, Raen M, Ostern AE. et al. Glaucoma and Intraocular Pressure in Patients Operated for Late In-the-bag Intraocular Lens Dislocation: A Randomized Clinical Trial. Am J Ophthalmol 2017; 176: 219-227 DOI: 10.1016/j.ajo.2017.01.026.