Phacoemulsifi.cation in eyes with pseudoexfoliation Liv Drolsum, MD, Erling Haaskjold, MD, Kjell Sandvig, MD ABSTRACT Purpose: To compare intraoperative and postoperative complications in eyes with and without pseudoexfoliation having cataract surgery by phacoemulsificati on . Setting: Department of Ophthalmology, National Hospital, Oslo, Norway. Methods: Of 1152 consecutive phacoemulsification procedures, 164 cases with pseudoexfoliati on (Group 1} and 916 cases without (Group 2) were followed for 4 months after cataract surgery in a prospective study. Of all cataract operations performed during that time, 96.2% were phacoemulsification procedures: 90.4 and 97.4% in eyes with and wi thout pseudoexfoliation, respectively (P < .0005). Results: The frequency of capsular/zonular tear or vitreous loss was 9.6 and 3.7% in Groups 1 and 2, respectively (P = .0002). A visual acuity of 0.5 or better was achieved in 86.5% of eyes in Group 1 and 92.4% in Group 2 (P = .02} . There were no statistically significant between-group differences in the frequency of a postop- erative inflammatory response 1 day (6.7 versus 4.4%}, 1 week (2.4 versus 1.6%}, or 4 months (1 .8 versus 0.9%) postoperatively. Conclusion: Phacoemulsification was safe in most eyes with pseudoexfoliation even though significantly more complications occurred intraoperatively in these eyes. The low frequency of an inflammatory response indicates that the presence of pseudoexfoliation does not significantly increase the risk of inflammation. J Cataract Refract Surg 1998; 24:787- 792 I mprovements in techniques and instruments have established phacoemulsification as a popular cataract extraction technique. Patients who have other concur- rent eye diseases may, however, be at increased risk of intraoperative problems using this procedure. In eyes with pseudoexfoliation, for example, the capsule and the zonules may be weakenedL 2 and the pupil poorly dilated. 3 · 4 Furthermore, the iris is degenerated with defects in the pigmented pupillary margin 5 • 6 and the iris vessels are pathologicaU- 9 Thus, the presence of pseudoexfoliation in an eye may cause complications during phacoemulsification. From the Department of Ophthalmology, National Hospital, Oslo, Norway. Reprint requests to Liv Drolsum, MD, Department of Ophthalmology, Central Hospital of Buskerud, 3004 Drammen, Norway. In two previous studies, 10 • 11 we found a high fre- quency of an inflammatory response after cataract surgery in eyes with pseudoexfoliation. About 80% of the procedures by manual lens extraction. A clear association was found between small pupil size and inflammation. We suggested that the increased inflam- mation rate in these eyes was a consequence of express- ing the nucleus through a small pupil with subse- quently increased surgical trauma rather than the presence of the pseudoexfoliative material. Other stud- ies12·13 also found increased postoperative inflammation in eyes with pseudoexfoliation having manual lens extraction. J CATARACT REFRACT SURG-VOL 24, JUNE 1998 787