AbstractPseudoexfoliation [PEX] syndrome is a common age – related disorder of the extracellular matrix that is frequently associated with severe chronic secondary open angle glaucoma and cataract. PEX syndrome may affect up to 30% of people older than 60 in a worldwide distribution and is biomicroscopically diagnosed by abnormal fibrillar deposits on ocular structures that line the aqueous bathed surfaces of the anterior segment. Often associated with the need for intraocular surgery, results of cataract and
glaucoma filtering surgery in eyes with PEX in the early stages of disease may be comparable to those in eyes without PEX, in the later stages morbidity is significantly increased due to periocular surgical complications and the outcome is worse. Surgical and postoperative difficulties are often multifactorial and are directly related to the pathological changes of PEX on intraocular structures. Although the visible areas of the anterior capsule are most obviously involved, this is only a small part of the picture
and of least significance. Biomicroscopically invisible changes of the zonules and their attachments are of the greatest consequence as they lead to zonular dialysis and subluxation of lens. In relation to the surgical management of these patients, the importance of early recognition of the pathological features, expectations of higher complication rate and having a plan to deal with them, taking adequate time
for the surgery, close attention to postoperative follow–up and a well informed patient with realistic expectations cannot be overemphasized. Keywords: Pseudoexfoliation Syndrome; Zonular Dialysis; Subluxation.
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