Cases of pseudophakic pseudoexfoliation in glaucoma patients

Abstract

We present cases of primary open angle glaucoma patients without previous history of pseudoexfoliation who developed pseudoexfoliative materials on the anterior surface of the intraocular lens after cataract surgery. Among 5 unilateral pseudophakic pseudoexfoliation cases, 3 showed a more advanced state of glaucoma in the affected eye. The other 2 cases showed progression of glaucoma in the affected eye after the development of pseudophakic pseudoexfoliation, while the unaffected eyes remained stable. In the latter 2 cases, control of intraocular pressure was difficult, and more glaucoma medication was needed in the affected eye. Pseudophakic pseudoexfoliation in glaucoma patients with no history of pseudoexfoliation syndrome or pseudoexfoliative glaucoma has not been reported. In our cases, the eyes which developed pseudophakic pseudoexfoliation showed a more advanced state of glaucoma, more difficulty controlling intraocular pressure, and faster progression of glaucoma. More observation is needed, but we cautiously postulate that pseudophakic pseudoexfoliation may have a role as a clinical risk factor in the prediction of glaucoma progression.

Keywords: Glaucoma; Glaucoma progression; Pseudophakic pseudoexfoliation.

Fig. 1

Photograph of the affected left eye of patient 1. (A) View of dilated pupil shows concentric ring on the intraocular lens (IOL) optic. (B) A detailed view shows fine, spoke-like opacities on the IOL optic with radial striations. There is a clear zone between the capsulorhexis margin and the opacities.

Fig. 2

Patient 2. Disc photographs of right (A) and left (B) eyes showing a more advanced state of glaucoma in the affected left eye. (C) A view of the fine deposits on the intraocular lens surface in the left eye.

Fig. 3

Photograph and visual field printout of the affected right eye of patient 4. (A) View of dilated pupil shows deposits on the anterior surface of the intraocular lens optic, which is more pronounced on the superior side. (B) A detailed view shows fine, dot-like deposits with radial striations. (C) Glaucoma progression analysis using the Humphrey Field Analyzer shows progression of glaucoma in the right eye.