Disorders associated with PXF
With respect to the ocular surface, patients with PXF appear to have higher predisposition of tear function disorders. One study, using the Schirmer II test and assessment of lid parallel conjunctival folds in PXF patients, demonstrated that there was a statistically significant difference in tear film break-up time compared to controlled patients.3
There is also an up-regulation of the non-specific inflammatory marker MMP-9 (matrix metalloproteinase-9) in tear film in PXF-syndrome.4 Studies show tear osmolarity is higher in both eyes of patients when compared with normal subjects, and pseudoexfoliation is suggested to alter basic features of goblet cell morphology—thus affecting tear film stability.5,6
PXF can cause zonular weakness that can allow for excessive lens movement, or dislocation, at the time of cataract surgery. Postoperative inflammation and corneal edema associated with cataract surgery may also be increased in eye with PXF.7
Naturally, I discussed all these things with my mother.
Related: First-class dry eye treatment
Fast forward to Mom’s post-operative statement, “I have no pain.”
My mother had no comment about her vision, or her lack of possible PXF-related complications. The comfort of her eye was the key indicator of success in her surgery.
It surprised me that in light of my concerns, it was only lack of discomfort that my mother discussed. This exercise made me re-evaluate my cataract surgery procedures and how I discuss surgery with patients.
Would it be better to start by saying, “We expect minimal postoperative discomfort?”
1.Miglior S, Bertuzzi F. Exfoliative glaucoma: new evidence in the pathogenesis and treatment. Prog Brain Res. 2015;221:233-41
2. Wiggs JL, Pasquale LR. Expression and regulation of LOXL1 and elastin-related genes in eyes with exfoliation syndrome. J Glaucoma. 2014 Oct-Nov;23(8 Suppl 1):S62-63
3. Škegro I, SuiÄ SP, KordiÄ R, JandrokoviÄ S, PetriÄek I, Kuzman M, PeriÄ S, Masnec S. Ocular surface disease in pseudoexfoliation syndrome. Coll Antropol. 2015 Mar;39(1):43-5.
4. Zimmermann N, Erb C. [Immunoassay for matrix metalloproteinase-9 in the tear film of patients with pseudoexfoliation syndrome - a pilot study]. Klin Monbl Augenheilkd. 2013 Aug;230(8):804-7.
5. Öncel BA, Pinarci E, Akova YA. Tear osmolarity in unilateral pseudoexfoliation syndrome. Clin Exp Optom. 2012 Sep;95(5):506-9.
6. Kozobolis VP, Christodoulakis EV, Naoumidi II, Siganos CS, Detorakis ET, Pallikaris LG. Study of conjunctival goblet cell morphology and tear film stability in pseudoexfoliation syndrome. Graefes Arch Clin Exp Ophthalmol. 2004 Jun;242(6):478-83.
7. Shingleton BJ, Crandall AS, Ahmed II. Pseudoexfoliation and the cataract surgeon: preoperative, intraoperative, and postoperative issues related to intraocular pressure, cataract, and intraocular lenses. J Cataract Refract Surg. 2009 Jun;35(6):1101-20.