High prevalence of zonulopathy in primary angle-closure
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Authors:
Anthony Fanous1, Ali
Salimi2, Harrison Watt1, Mohammed Abu-Nada1,
Paul Harasymowycz3.
1Faculty of Medicine, McGill University, 2Department of
Ophthalmology, Faculty of Medicine, McGill University, 3Montreal
Glaucoma Institute and Bellevue Ophthalmology Clinics.
Author Disclosure Block:A. Fanous: None. A. Salimi: None. H. Watt: None. M. Abu-Nada: None. P. Harasymowycz: Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Allergan, Glaukos, Ivantis, Johnson & Johnson Vision, and Alcon.. Any direct financial payments including receipt of honoraria; Description of relationship(s); Consultant.
Abstract Body:
Purpose: Intraocular surgeries in patients
with zonular weakness are challenging and are at increased risk of
intraoperative and postoperative complications. The prevalence of zonulopathy
has been previously reported for the general population; however, the evidence
among angle-closure eyes is scarce. The present study aimed to assess the
prevalence of zonulopathy among a large cohort of angle-closure eyes that
underwent cataract surgery as a stand-alone procedure or combined with glaucoma
procedures.
Study Design: Retrospective consecutive case-series.
Methods: This retrospective case-series comprised of angle-closure eyes
that underwent phacoemulsification cataract surgery at a single ophthalmology
center between 2009 and 2020. Those with known risk factors for zonulopathy
such as history of trauma, pseudo-exfoliation syndrome, previous intraocular
surgery, retinitis pigmentosa, or connective tissue disorders were excluded.
The primary outcomes included the prevalence of zonulopathy assessed
intraoperatively and secondary pigment dispersion syndrome (SPDS). Secondary
outcomes included postoperative best-corrected visual acuity (BCVA) changes,
intraoperative complications, and postoperative adverse events.
Results: A total of 806 eyes of 465 patients with an average age of
65.7±10.7 years were included. Angle-closure diagnoses included primary
angle-closure suspects (PACS) in 21%, primary angle-closure (PAC) in 43%, and
primary angle-closure glaucoma (PACG) in 36% of the eyes. Intraoperative signs
of zonular weakness were evidenced among 59 eyes (7.3% of the cohort),
including floppy capsule (29 eyes, 3.6%), zonular laxity (22 eyes, 2.7%), and
zonular dehiscence (8 eyes, 1.0%). In our cohort of angle-closure eyes, the
prevalence of zonulopathy was significantly greater than the 0.6% to 2.6% range
reported for the general population (p<0.001). SPDS was observed in 141 eyes
(17.5%). Vision significantly improved from 0.27±0.51 logMAR preoperatively to
0.17±0.39 at the first postoperative month (p<0.001). Among the 59 eyes with
zonulopathy, capsular tension ring was used in 23 eyes (39.0%), six eyes
(10.2%) experienced vitreous prolapse intraoperatively and underwent anterior
vitrectomy, and one eye experienced posterior capsular rupture.
Conclusions: Zonulopathy is an under-recognized pathology that poses an
increased risk of intraoperative and postoperative adverse events. The present
study evidenced a high prevalence of zonulopathy among angle-closure eyes.
Awareness about the prevalence of this pathology in angle-closure coupled with
a careful preoperative examination can help minimize or prevent the adverse
events associated with zonulopathy.