Inter-eye differences in patients with pseudoexfoliation syndrome presenting with intraocular lens dislocation.

Objective: 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.

Methods: Retrospective matched case-control study. Eyes presenting with IOL dislocation (case group) were compared with fellow eyes (control group). Methods: 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. Methods: 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.