Total Lens Dislocation Caused by Pseuodexfoliation



Peter Glasman, Ivan Yip, Carl Groenwald, Anshoo Choudhary



Peter James Glasman, Ivan Yip, Carl Groenwald, Anshoo Choudhary, St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom

Correspondence to: Peter James Glasman, St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom


Telephone: +44-151-7062000

Received: January 27, 2015              Revised: February 10, 2015

Accepted: February 14, 2015

Published online: June 1, 2015



Pseudoexfoliation (PXF) is a well-known cause of complications during cataract surgery, particularly dropped nucleus and vitreous loss. Such complications must be managed by appropriate vitreoretinal intervention.


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Key words: Cataract surgery; Complications; Vitreous loss


Glasman PJ, Yip I, Groenwald C, Choudhary A. Total Lens Dislocation Caused by Pseuodexfoliation. International Journal of Ophthalmic Research 2015; 1(1): 32-33 Available from: URL:



A 78 year old lady underwent cataract surgery. Pseudoexfoliation (PXF) and phacodonesis were noted pre-operatively, but the eye was otherwise healthy. The intraocular pressure was normal, the pupil dilated well and there was no glaucomatous neuropathy. On the operating table, the crystalline lens was quite mobile but capsulorrhexis and hyrdodissection were completed satisfactorily. All the zonules appeared to be weak as there was no decentration in any particular direction. However, the lens was too mobile to safely continue phacoemulsification and it was therefore decided to stabilise the lens with insertion of a capsular tension ring. Just as the ring was inserted, the entire lens dislocated into the vitreous cavity and required removal by pars plana vitrectomy (Figure 1).



PXF is a systemic disorder of unknown cause whereby amyloid-like proteins are abnormally deposited throughout the body. The condition can be found worldwide but is much more common in certain geographical areas, particularly Scandinavia. The chief manifestations are in the eye, where it can be discerned by slit lamp examination; it is a common cause of secondary glaucoma and is also associated with complications during cataract surgery, owing to lens/zonular instability. However, it may also manifest itself systemically, with evidence implicating PXF in cardiovascular diseases such as abdominal aortic anuerysm[1], renal artery stenosis[2], heart disease and stroke[3].

    PXF is strongly associated with complications during cataract surgery, with a vitreous loss rate of up to 27%[4]. Surgical strategies which may be indicated include pupil enlargement manoeuvres (stretching, iris hooks or the Malyugin ring), extreme caution when inflating the anterior chamber or performing hydrodissection and capsular tension ring or sutured tension ring (Cionni) segment insertion. In cases where phacodonesis is evident pre-operatively, it may be wise to refer the patient to a vitreo-retinal surgeon.



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1    Pseudoexfoliation syndrome and aneurysms of the abdominal aorta. Schumacher S et al. Lancet 2001, 357: 359-60.

2.   Renal artery stenosis and abdominal aorta aneurysm in patients with pseudoexfoliation syndrome. Gonen KA, Gonen T, Gumus B.  Eye 2013, 27(6):735-41.

3.   Shrum KR, Hattenhauer MG, Hodge D (2000) Cardiovascular and cerebrovascular mortality associated with ocular pseudoexfoliation. Am J Ophthalmol 129: 83-86.

4.   Naumann GO, Schlötzer-Schrehardt U, Küchle M (1998) Pseudoexfoliation syndrome for the comprehensive ophthalmologist. Intraocular and systemic manifestations. Ophthalmology 105: 951-968.


Peer reviewer: Gabor Hollo, MD, PhD, DSc, Professor of Ophthalmology, Department of Ophthalmology, Semmelweis University, Maria u. 39. Budapest, Hungary.



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