Eyeworld

SPRING 2025 | EYEWORLD | 107 G Reference 1. Schlötzer-Schrehardt U, Nau- mann G. Ocular and systemic pseudoexfoliation syndrome. Am J Ophthalmol. 2006;141:921–937. Relevant disclosures Halenda: None Krause: None Contact Halenda: kevin.halenda1@hsc.wvu.edu Krause: XDB3ME@uvahealth.org Management Dr. Krause said management with drops or SLT are both reasonable initial treatment strategies. Though, he noted, the effect of SLT may dimin- ish more quickly in patients with pseudoexfolia- tion glaucoma. "Since these patients often present with advanced damage, a surgical procedure is often necessary," Dr. Krause added. "If possible, this should be combined with cataract surgery. An- gle-based procedures like a goniotomy, Hydrus Microstent [Alcon], Omni [Sight Sciences], or iTrack Advance [Nova Eye Medical] are good minimally invasive options. However, filtration surgery with a XEN 45 Gel Stent [AbbVie], trab- eculectomy, or glaucoma drainage implant may be required." Dr. Krause said that someday suprachoroi- dal shunts would be a welcome option to treat pseudoexfoliation glaucoma patients. Dr. Halenda said he prefers excisional procedures such as trabeculotomy or goniotomy when se- lecting MIGS for these patients. Dr. Halenda said for all surgeries with this condition, patients can have more prolonged and profound inflammation. As such, they may require more aggressive and prolonged steroid tapers than typical. Considerations for cataract surgery There is a higher rate of complications for cata- ract surgery in patients with pseudoexfoliation syndrome, according to Dr. Halenda, primarily due to the effect of the condition on the zonules compromising lens stability. He said it's important to create a large enough capsulorhexis for these patients because they're at higher risk for capsular phimosis later on, which could contribute to lens dislocation. He also said it's important to minimize lens rotation, making sure there is adequate hydro- dissection and potentially use of phaco-chop techniques. Dr. Halenda said there is an increased risk of vitreous loss and zonular damage during cat- aract surgery in patients with pseudoexfoliation. In addition, the exfoliative material affecting the iris might necessitate use of a pupillary expansion ring or iris hooks. For lens instability, a capsular tension segment or capsular hooks might be needed. "Some surgeons advocate for placing a 3-piece IOL in the capsule because it exerts a little more tension, which can increase stabili- ty," he said. "Also, the exfoliative material does compromise the corneal endothelium, so they're at greater risk for corneal decompensation after cataract surgery or any other intraocular surgery." Finally, Dr. Halenda said that these patients have a higher risk of IOP spikes after cataract surgery, especially if a MIGS procedure wasn't performed. Thus, he said "it's important to thor- oughly irrigate the viscoelastic out of the eye after surgery." Lorraine Provencher, MD, EyeWorld Glaucoma Editorial Board member, shared what she is excited for at the ASCRS Annual Meeting: "I love the ASCRS Annual Meeting! The content is highly relevant to anterior segment surgeons of all levels, but my favorite part is seeing all of my friends and colleagues." ASCRS ANNUAL MEETING P R E V I E W

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