The effect of zonular support devices on intraocular pressure in patients with pseudoexfoliation glaucoma

Abstract

Objective: to study the effect of various types of zonular support devices on intraocular pressure in patients with pseudo exfoliative glaucoma after cataract phacoemulsification. Material and methods: The results of surgical treatment of complicated cataract by phacoemulsification in 920 patients (1015 eyes) with pseudoexfoliation syndrome from 2015 to 2017 were analyzed. Glaucoma was detected in 137 patients (161 eyes). Zonular weakness was revealed in 82 patients (93 eyes) that were included to the study and divided into the groups. The first group consisted of 21 eyes - without capsular tension ring with isolated phakodenesis (the first stage). The second group consisted of 49 eyes using capsular tension ring. The remaining 23 eyes formed the third group, where the modified capsular tension ring with suture fixation was used. Results: Intraocular pressure average decreasing was detected in 21.5% and reduction of glaucoma drug use was noted in 42.8% of the baseline in the group with phakodenesis without using capsular tension ring. The intraocular pressure indices in the group with the suture fixation of the modified capsular tension ring were decreased in average in 24.2% and the number of drugs - in 37.9% in comparison with preoperative indicators. In one case was revealed pseudophacodenesis, uncontrolled intraocular pressure, that required glaucoma surgery performing. In the group with capsular tension ring implantation, was a slight decrease in intraocular pressure in 10.7% and a reducing in drugs use in 14.3% (p≥0.05), in 8 cases from 13 eyes with iridophacodenesis remained pseudophacodenesis. There was no intraocular pressure compensation that required glaucoma surgery. Conclusion: Elimination of the «intraocular lens-capsular bag» complex mobility in the surgical treatment of complicated cataract in patients with pseudoexfoliation syndrome is the leading mechanism of intraocular pressure compensation. The use of a modified capsular tension ring with suture fixation affects the intraocular pressure decrease and is recommended not only to stabilize the capsular bag in lens subluxation cases, but also in iridophacodenesis in patients with glaucoma and zonular weakness. Isolated capsular tension ring use is ineffective for reducing intraocular pressure in patients with pseudoexfoliation syndrome in the presence of iridophacodenesis.