Prevalence of zonulopathy in primary angle-closure.

Abstract

BACKGROUND\nTo determine the prevalence of zonulopathy in a large cohort of angle-closure eyes that underwent cataract surgery.\n\n\nMETHODS\nRetrospective consecutive case series of primary angle-closure eyes that underwent phacoemulsification cataract surgery or clear lens extraction between 2009-2020 at a single ophthalmology centre. Those with risk factors for zonulopathy such as history of trauma, pseudoexfoliation syndrome, 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.\n\n\nRESULTS\nIn our cohort of 806 consecutive eyes with primary angle-closure, the prevalence of zonulopathy was 7.3% (59 of 806 eyes) - significantly greater than the 0.46% to 2.6% range reported for the general population (p\u2009<\u20090.001). Intraoperative signs of zonular weakness included floppy capsular bag (29 eyes, 3.6%), zonular laxity (25 eyes, 3.1%), and zonular dehiscence (11 eyes, 1.4%). Among these eyes, capsular tension ring was used in 23 eyes (39.0%), six eyes (10.2%) experienced vitreous prolapse intraoperatively and underwent anterior vitrectomy, and two eyes (3.4%) experienced posterior capsular rupture, one of which required scleral-fixated intraocular lens. Secondary pigment dispersion syndrome was observed in 141 eyes (17.5%).\n\n\nCONCLUSIONS\nThis study evidenced a high prevalence of zonulopathy among a large cohort of angle-closure eyes and suggests zonulopathy as a possible under-recognized cause of angle-closure. Until more sophisticated imaging modalities become available, awareness about the prevalence of zonulopathy in angle-closure coupled with careful preoperative examinations can help minimize or prevent the complications of zonulopathy. This article is protected by copyright. All rights reserved.