The following is a summary of “Risk factors for a phacodonesis surprise during cataract surgery in patients with pseudoexfoliation,” published in the September 2023 issue of Opthalmology by Buhbut et al.
Researchers performed a retrospective study to identify pre-operative parameters associated with surprise phacodonesis in pseudoexfoliation (PXF) cataract surgery.
They reviewed all PXF patients who had cataract surgery from 2013 to 2018. Pre-operative parameters were compared (including demographics, biometry, intraocular pressure (IOP), endothelial cell count, pupil size, cataract density, glaucoma status, cup-to-disc ratio, number of glaucoma medications, prior intra-vitreous injections, and risk for intraoperative floppy iris syndrome) between patients with and without surprise phacodonesis. Predictive values for each parameter were calculated using binary logistic regression.
The results showed 127 eyes from 120 PXF patients (mean age 77.8 ± 12.0 years, 52.7% male) who underwent computerized pre-operative assessment were included out of 396 surgical cases. During surgery, 10 cases (8.2%) exhibited surprise phacodonesis. These cases had higher pre-operative IOP (23.0 ± 11.0 mmHg vs. 14.9 ± 3.8 mmHg, P<0.001) and a higher rate of B-scan use due to dense cataract obscuring posterior pole evaluation (40% vs. 12.8%, P=0.04) compared to PXF cases without intraoperative phacodonesis. Multivariate binary logistic regression confirmed that only baseline IOP significantly predicted surprise phacodonesis (OR 1.22, CI 1.04–1.43, P=0.014).
Investigators concluded that elevated IOP and poor posterior segment visibility requiring B-scan use in PXF cataract surgery increase the risk of intraoperative complications.