Detection of Lens Subluxation in Pseudoexfoliation

Abstract

To the Editor. —The association between pseudoexfoliation and lens subluxation is well known. It is especially important to detect both conditions before planned extracapsular cataract surgery. I have seen several patients with pseudoexfoliation in whom only a slight phacodenesis was present. The phacodenesis was relatively easy to detect if the pupil was undilated. It was only barely perceptible, if at all, with the pupil dilated. I usually use cycloplegics to dilate the pupils in my patients. It is theoretically possible that tightening of the zonules by the cycloplegic may stabilize the lens and decrease the phacodenesis. It is also possible that movement of the anterior surface of the lens relative to the pupillary border is easier to observe with a small pupil, especially if pigment or pseudoexfoliation material is present on the surface of the lens. If my observation is correct, it would be especially important to look for phacodenesis