EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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63 EW RESIDENTS May 2015 References 1. Davis D, Brubaker J, Espandar L, Stringham J, Crandall A, Werner L, Mamalis N. Late in-the- bag spontaneous intraocular lens dislocation; evaluation of 86 consecutive cases. Ophthalmology 2009;116:664–670. 2. Jehan FS, Mamalis N, Crandall AS. Spontaneous late dislocation of intraocular lens within the capsu- lar bag in pseudoexfoliation patients. Ophthalmology 2001;108:1727–1731. 3. Werner L, Zaugg B, Neuhann T, Burrow M, Tetz M. In-the-bag capsular tension ring and intraocular lens subluxation or dislocation: a series of 23 cases. Ophthalmology 2012; 119:266–271. 4. Ringvold A, Blika S, Elsås T, Guldahl J, Brevik T, Hesstvedt P, Johnsen H, Hoff K, Høisen H, Kjørsvik S, Rossvoll I. The Middle-Norway eye-screening study I. Epidemiology of the pseudo-exfoliation syndrome. Acta Ophthalmol 1988;66:652–658. 5. Orzalesi N, Aschero M, Autelitano A. Epidemiol- ogy of pseudoexfoliation. New Trends Ophthalmol 1993;8:131–134. 6. Thorleifsson G, Magnusson KP, Sulem P, Walters GB, Gudbjartsson DF, Stefansson H, Jonsson T, Jonasdottir A, Jonasdottir A, Stefansdottir G, Masson G, Hardarson GA, Petursson H, Arnarsson A, Motal- lebipour M, Wallerman O, Wadelius C, Gulcher JR, Thorsteinsdottir U, Kong A, Jonasson F, Stefansson genetic testing and advanced imag- ing techniques may be employed to aid in identifying patients with PXF. Morbidity from this systemic condi- tion extends beyond ocular condi- tions, as PXF has been implicated in cardiac and renal conditions as well. 9 The main outcomes of this study are centered around the clini- cal and histopathologic diagnosis of PXF. The authors describe the meth- ods as to which preop clinical data was obtained; however, additional information such as the criteria used for clinical diagnosis of PXF, the number of examinations prior to initial cataract surgery, and further data gathered from the surgeon questionnaire could also be useful in interpreting the results of this study. The authors acknowledge that his- topathologic diagnosis of PXF alone might not have captured all the specimens with PXF, and that utiliz- ing ultrastructural evaluation with transmission and scanning electron microscopy may have resulted in an even higher yield of PXF cases. Lead time bias, small sample size and the homogenous population at a single institution are other limitations of the study. Liu et al demonstrate that our ability to identify patients with PXF and other causes of zonular weak- ness preoperatively is limited. Preop- erative diagnosis of these conditions allows for the surgeon to modify surgical technique in order to yield improved outcomes and possibly prevent late in-the-bag subluxation or dislocation. The authors cite a study that utilized capsular hooks, CTRs, and sulcus IOL placement with optic capture as a method to maximize capsule stability. 10,11 Fur- ther studies are necessary to provide a better understanding of PXF and enhanced techniques for preopera- tive assessment. In addition, studies evaluating surgical methods that provide maximal capsular stability would be beneficial in providing improved outcomes in this high-risk patient population. EW K. Common sequence variants in the LOXL1 gene confer susceptibility to exfoliation glaucoma. Science 2007;317:1397–1400. 7. Lens and Cataract. San Francisco, CA: American Academy of Ophthalmology, 2012. Chapter 4: Pathology (2013). Basic and clinical science course 2013–2014, Lens and Cataract (pp. 61–62). San Francisco, CA: American Academy Of Ophthalmol- ogy. 8. Ritch R, Schlötzer-Schrehardt U. Exfoliation syndrome. Surv Ophthalmol 2001;45:265–315. 9. Ritch R. Ocular and systemic manifestations of exfoliation syndrome. J Glaucoma 2014 Oct– Nov;23(8 Suppl 1):S1–8. 10. Devranoglu K, Kılıç A, Özdamar A, Yurtsever AK. Intraocular lens optic capture in eyes with zonular weakness in cataract patients. J Cataract Refract Surg 2013;39:669–672. 11. Rosenthal KJ. Improving surgical outcomes with capsular tension rings. Rev Ophthalmol 2001;8:47–56. Contact information Gupta: angupta@NYEE.edu pseudoexfoliation in subluxation or dislocation" New York Eye and Ear Infi mary of Mount Sinai ophthalmology residents and PD. Front row (left to right): Jeanie Paik, MD, Alicia Menezes, MD, Andrew Kao, MD, Xuan Tashin Le-Nguyen, MD, Anita Gupta, MD, Natasha Nayak, MD, Andrew Garcia, MD, Helen Yeung, MD, Dipika Joshi, MD, and Julia Mathew-Padiyedathu, MD. Back row (left to right): Jonathan Brugger, MD, Khoa Pham, MD, Jerome Giovinazzo, MD, Nicole Scripsema, MD, Ruidi Wang, MD, Andrew Nightingale, MD, Kevin Lai, MD, and Zane Anwar, MD Source: New York Eye and Ear Infi mary of Mount Sinai