Razi Journal of Medical Sciences

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Akbari M, Soltani Moghadam R, Mohamadpour A, Kazemnezhad Leili E, Azaripour E, Sabouri M R. Comparison of the Frequency of Lens Capsule Opacification And Phimosis, Vision Changes, and Intraocular Pressure after Cataract Surgery in Patients with Pseudoexfoliation Syndrome with and Without the Use of Nonsteroidal Anti-Inflammatory Drops. RJMS 2025; 32 (1) :1-11
URL: http://rjms.iums.ac.ir/article-1-9021-en.html

Background & Aims: Pseudoexfoliation syndrome is a systemic disease in which extracellular matrix of fibrillar material is deposited in many organs. In the eye, this white fibrinogranular material resembling basement membrane is formed on the lens, cornea, iris, anterior hyaloid, ciliary processes, zenular fibers and trabecular meshwork. These deposits, which consist of elastic microfibrils, appear as grayish-white flecks that are characterized by the pupil margin and lens capsule. Associated features of this syndrome include: iris atrophy at the pupil margin, pigment deposition on the anterior surface of the iris, a pupil that is difficult to dilate, increased pigmentation of the trabecular meshwork, capsular fragility, zenular weakness, and open-angle glaucoma. Pseudoexfoliation syndrome is a unilateral or bilateral disease that is characterized by increased age. Increased oxidative stress due to increased TGF-β levels is implicated in the development of cataracts in these cases. Patients with this syndrome may have zenular fiber weakness and spontaneous lens displacement and phycodonosis. Zenular weakness may affect cataract surgical technique and IOL placement. Exfoliative material may be produced even after removal of the crystalline lens. Nonsteroidal anti-inflammatory drugs have been investigated for the treatment of inflammation and pain after cataract surgery. Although topical NSAIDs control inflammation after cataract surgery, there is little information on whether NSAIDs combined with topical steroids can further reduce inflammation after cataract surgery. In the present study, the frequency of anterior capsule opacification and phimosis, visual changes, and IOP after cataract surgery in patients with pseudoexfoliation syndrome were compared.
Methods: In this Randomized Clinical Trial, 88 patients with cataract with pseudoexfoliation syndrome who were candidates for phacoemulsification surgery were randomly assigned to 2 groups. From the first day after surgery, 0.5% chloramphenicol and 0.1% betamethasone drops were used in the first group, and in the second group, 0.5% ketorolac tromethamine drops were used in addition to these drops for two weeks. In the two groups, the degree of anterior chamber inflammation, intraocular pressure (IOP), Best Corrected Visual Acuity (BCVA) on days 1, 3, 7, and 30 after surgery, and the degree of anterior capsule opacification and anterior capsule phimosis at the sixth month of follow-up were recorded. Inclusion criteria included significant cataract (grade 3 and above) with PEX on slit lamp examination, no history of taking any oral, inhaled, or topical NSAID one week before surgery, and no history of taking any systemic, inhaled, or topical corticosteroids within 15 days before surgery. Exclusion criteria included sensitivity to NSAID compounds, history of uncontrolled chronic and systemic ocular disease, history of ocular inflammation or trauma, intraoperative complications such as posterior capsule rupture and vitreous loss, extracapsular or intracapsular cataract surgery, and need for systemic anti-inflammatory drugs due to severe postoperative inflammation.
Results: In this study, the average vision of patients in both groups improved compared to before surgery at all follow-up times, and there was no statistically significant difference between the two study groups (p>0.05). The average intraocular pressure of patients in the first follow-up after surgery did not have a numerical or statistical difference compared to before surgery, and there was no significant difference between the two groups (p>0.05). The rate of anterior capsule opacity and anterior capsule phimosis in the group receiving Ketorolac drops was clearly lower than in the other study group, so that this reduction is statistically significant.
Conclusion: According to the results of the present study, the use of nonsteroidal anti-inflammatory (NSAID) drops in pseudoexfoliation patients can help improve vision and intraocular pressure after surgery, as well as reduce the complications of capsular opacities and capsular phimosis. The mean intraocular pressure of the patients in the first follow-up after surgery did not have a significant numerical or statistical difference compared to before surgery, and no significant difference was observed in the comparison between the two groups (p>0.05). In the comparison of the mean IOP reduction between the two groups, the statistical difference in the first and sixth months was close to being significant, P value for the first month (p=0.022) and sixth month (p=0.055), respectively; but in other follow-ups, no significant difference was observed between the two groups. In the present study, the postoperative inflammation rate in the ketorolac group was clearly lower than in the other study group, so that this reduction, which is statistically significant, starts from the third day after surgery based on the degree of cell and flare in the anterior chamber and continues until the one-month follow-up. PEX patients are prone to more inflammation, especially in the first days after phacoemulsification surgery, due to the deposition of fibrillar materials inside the eye. In a prospective study by Sufi et al. in Kashmir, it was observed that PEX-positive patients had higher degrees of inflammation and increased intraocular pressure after phacoemulsification surgery (p<0.05).