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

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