What pre-operative features in pseudoexfoliation patients do you feel correlate with intra-op zonulopathy?

This is an excellent question. Several factors play a role in the extent of zonulopathy that one may expect during pseudoexfoliation cases. A history of zonulopathy in the other eye or other factors that could contribute (trauma, falls, prior surgeries like retina procedures) would be one thing to l...

I would advise being prepared to deal with zonulopathy in every PXF case. Although there is a correlation between the amount of PXF material and zonular loss, it is not a perfect correlation, and at times, even an eye with good dilation can have weak zonules. If a PXF patient has angle closure, I wo...

Unfortunately, the presence or amount of fibrillar material in the anterior segment (e.g., lens capsule, pupillary border, or TM) really does not seem to correlate with zonular status in my experience. That said, phacodonesis obviously is a big red flag, but also apposition of the anterior lens caps...

The patients who don't dilate well are much more likely to have weakened zonules, in my experience.

I agree with all of the points raised above. In pseudoexfoliation, I’ve found that it is often hard to truly predict the degree of zonulopathy preoperatively, but there are a few things I consistently pay attention to.

A history of zonular issues in the fellow eye is probably the most helpful clue. ...

The most predictable risk factor I have seen is unilateral cupping. Severe PXF glaucoma in 1 eye and mild in the other is a very ominous risk factor. Especially when coupled with unilateral/ipsilateral poor dilation.

In general, I would say the most important things are:

• Severity of glaucoma.
• Degre...

Agree with the above in that there is really no good “indicator” of zonulopathy. I really try to avoid downward pressure on the lens when doing these cases. I also try to minimize the rotational movement of the lens.

At the same time, I try to ensure a good hydro-dissection, as any “sticky” part of ...