Visual outcomes and complications of manual small-incision cataract surgery in patients with pseudoexfoliation

PURPOSE: Pseudoexfoliation is an age-related fibrillopathy characterized by the deposition of fibrillar material in the eye with an increased risk of complications during cataract surgery. Aim was to study visual outcomes and complications in patients with pseudoexfoliation undergoing manual small-incision cataract surgery (MSICS). METHODS: Prospective observational study was performed on 152 patients with pseudoexfoliation above 50 years undergoing MSICS in a tertiary hospital from December 2016 to November 2017. Intraoperative and postoperative complications were documented with follow-up on postoperative day 1, 1(st) week, 1(st) month, and 3(rd) month. RESULTS: Preoperative small pupil was noted in 49 eyes (32.2%), and 19 (12.5%) required intraoperative measures. Intraocular complications noted were zonular dialysis in five (3.3%), posterior capsular rupture in one (0.7%), and iridodialysis in one (0.7%). On postoperative day 1, the most common complication was corneal edema in 134 patients but clinically significant in only 23 (15.1%). Postoperative complications at 3 months were irregular pupil in 17 cases and decentered IOL in three cases. Intraocular pressure decreased with each visit [preoperative mean: 14.39 (±3.4) and 13.37 (±2.0) 12.53 (±1.4) mm Hg at 1 and 3 months, respectively]. There was a significant improvement in vision from the first day mean pinhole vision of 0.26 (±0.24) to mean best corrected visual acuity (BCVA) of 0.09 (±0.22) and 0.07 (±0.22) at 1 and 3 months, respectively. Mean endothelial cell loss was 193.16 (7.79%) and 266.01 (10.68%) at 1 and 3 months, respectively. CONCLUSION: Pseudoexfoliation has an increased risk of complications during cataract surgery. MSICS gives good outcomes in terms of visual recovery and postoperative outcomes.