Anterior chamber morphological and refractive outcomes following phacoemulsification in pseudoexfoliative eyes: A case-control study.

Abstract

Purpose: To compare changes in angle morphology, anterior chamber depth (ACD) and refractive prediction error (PE) after phacoemulsification between pseudoexfoliative (PEX) and non-PEX eyes.

Methods: Prospective case-control study of eyes submitted to cataract surgery. Biometric data and angle parameters - Anterior Chamber Angle (ACA), Angle Opening Distance (AOD), Scleral Spur Angles (SSA) and Trabecular Iris Space Area (TISA) - were measured preoperatively and 1-month postoperatively through swept-source anterior segment optical coherence tomography. Postoperative refractive prediction error (PE) was calculated using an optimized A-constant and the Kane formula.

Results: Sixty eyes (30 PEX and 30 non-PEX) of 60 patients were included. Preoperative angle analysis revealed a lower ACA, AOD, SSA and TISA in PEX group (p < 0.05), without biometric differences (p > 0.05). A tendency for a higher magnitude of morphometric angle changes in PEX eyes was observed, with a superior increase of SSA at 500 µm (0°) and TISA at 750 µm (0°) (p = 0.030 and p = 0.041, respectively). The anterior chamber deepened in both groups (p = 0.01), with arithmetic and percentile change being higher in PEX group (p = 0.017 and p = 0.047, respectively). A significant PE hyperopic shift was observed (p = 0.035) only in PEX group.

Conclusions: Pseudoexfoliative eyes with cataract have narrower angles, revealing a tendency for higher angle opening after surgery, along with an increased ACD deepening compared to non-PEX eyes, which may be explained by PEX-associated zonular laxity. Moreover, a significant hyperopic shift was observed in PEX eyes, a relevant fact to take into consideration when selecting intraocular lens power.