Inter-Eye Differences in Patients with Pseudoexfoliation Syndrome Presenting with Intraocular Lens Dislocation

Purpose: To analyze differences in glaucoma diagnosis and glaucoma severity between fellow eyes in patients with pseudoexfoliation syndrome (PXF) who present with intraocular lens (IOL) dislocation. Design: Retrospective matched case-control study. Eyes presenting with IOL dislocation (case group) were compared with fellow eyes (control group). Participants: Patients from a tertiary referral practice in Mississauga, Ontario, Canada. Methods: Consecutive patients with PXF and prior bilateral uneventful cataract surgeries with in-the-bag IOLs who presented with IOL dislocation between 2008 and 2013 were identified (n = 71). Indicators of glaucoma severity were compared between fellow eyes using McNemar's test and Wilcoxon signed-rank tests. Indicators of glaucoma severity were also compared pre- and post-IOL exchange/repositioning in the eye with IOL dislocation. Main Outcome Measures: Glaucoma diagnosis, corrected distance visual acuity (CDVA), intraocular pressure (IOP), optic nerve cup-to-disc (C/D) ratio, mean deviation (MD) on visual field, retinal nerve fiber layer (RNFL) thickness, and glaucoma medication requirements (GMRs). Results: Seventy-one participants were included. The affected eye was more likely to have glaucoma (P < 0.0001) and have more severe glaucoma (P = 0.0001). In addition, the affected eye had worse mean CDVA (1.14 +/- 0.79 logarithm of the minimum angle of resolution [logMAR] vs. 0.35 +/- 0.46 logMAR, P < 0.0005), higher mean IOP (19.2 +/- 7.2 vs. 14.7 +/- 3.6, P < 0.0005), higher C/D ratio (0.54 +/- 0.22 vs. 0.51 +/- 0.20, P +/- 0.006), greater mean number of glaucoma medication classes (1.4 +/- 1.4 vs. 0.5 +/- 1.1, P < 0.0005), worse MD (-13.83 +/- 6.89 decibels [dB] vs. -6.59 +/- 6.63 dB, P < 0.0005), and worse mean RNFL thickness (69.2 +/- 26.3 vs. 82.4 +/- 13.7, P = 0.001). In the affected eye, there were early postoperative improvements in mean CDVA, IOP, and GMRs. Conclusions: In patients with PXF, the eye presenting with IOL dislocation was more likely than its fellow eye to have a diagnosis of glaucoma and to have glaucoma of greater severity. (C) 2015 by the American Academy of Ophthalmology.