Cataract Surgery and Pseudoexfoliation
By Jeffrey Martin, MD
Published on March 24, 2010
A cataract is a natural clouding of the lens of the eye that occurs as we age. Most patients develop visually significant cataracts at a later age, but some develop cataracts earlier in life. The average cataract patient that needs cataract surgery is in their 70s or 80s, but certain medical conditions, medications, or inherited predispositions can cause cataract surgery to become necessary earlier in life.
Most cataract surgery is routine and is completed without complication. Patients tend to be pleased with the results of cataract surgery and they get to enjoy improved vision and functioning without pain or difficulty. Cataract surgery is only considered when the cataracts are causing a significant decrease in the patient's ability to perform activities of daily living. There are clinical conditions that can make cataract surgery more difficult.
Pseudoexfoliation is an eye condition that causes the connective tissue strings that connect the natural lens of the eye to the wall of the eye to become less supportive. Zonules are these connective tissue attachments and in pseudoexfoliation there are less zonules and they weaken over time. In cataract surgery, the cataract surgeon depends on the support of the zonules to complete cataract removal in a safe fashion. When the zonules are weak like they are in pseudoexfoliation, the lens can be more mobile and can even fall into the back of eye necessitating further surgery to remove it.
In most cases of pseudoexfoliation, a skilled and experienced cataract surgeon can complete the case without complication. Dr. Jeffrey Martin uses technology such as iris hooks, capsular tension rings, and capsule tension segments to support the lens through cataract surgery if necessary. Also, there are lens support devices that can be sutured in place to support the cataract during cataract surgery. It is important to have gentle cataract removal technique in cases of pseudoexfoliation.
Cataract surgery has advanced to the point that even in difficult cases, the outcomes of the surgery can be excellent. Dr. Martin says that continued innovation and improvement of technology and technique help the progress of eye surgery.