Severe Pseudoexfoliation Syndrome (Video)

This video shows an eye suffering from severe pseudoexfoliation syndrome of the lens. This has caused glaucoma and will make his cataract surgery difficult. In this movie, you can see the white PXF material on the surface of the lens – it looks radially oriented because the iris rubs against the lens at this point.

PXF is an important finding as it will make cataract surgery difficult. The basement-membrane material also adheres to the lens zonules, making them prone to breakage during surgery. This could lead to zonular dehiscense, vitreous loss, or even late lens dislocation.

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The white material on the surface of the cataractous lens rubs on the back surface of the iris, releasing pigment in the eye that clogs the trabecular drain. This can create a PXE glaucoma from insufficient aqueous outflow.
Pseudoexfoliation is also an important finding to note prior to considering cataract surgery. The basement membrane also forms on the lens zonules, making them prone to breaking during surgery … leading to vitreous loss, zonular dehiscense, and even late lens dislocation.
This microscope photograph shows an eye with pseudoexfoliation syndrome. You can see the white, basement-membrane material sitting on the surface of the lens. This debris rubs on the overlying iris and can cause glaucoma from trabecular meshwork clogging. Also, this findings indicates a higher risk for zonular dehiscence during cataract surgery.

Dr. Timothy Root is a practicing ophthalmologist and cataract surgeon in Daytona Beach, Florida. His books, video lectures, and training resources can be found at:


  1. How do you treat pseudoexfoliation? If there is a treatment– should that treatment start immediately upon detection? Can pseudoexfoliation be treated before cataract surgery is performed? Should cataract surgery be attempted when pseudoexfoliation is present? What is the chance of successful cataract surgery when pseudoexfoliation is present?

  2. I would like to know the answers to all the questiongin the comment shown above by Carol Simmerman on Oct. 16, 2009 4:08 pm because I have this problem and I was trying to find info on this at the same time she was. I also have a cataract on my right eye and am close to surgery for that.

  3. My husband suddenly, sinced Dec 2,2010 presents pseudoexfoliation,in his left eye and catarat on his right eye. I would like to know the answers to all questiongin by Carol Zimmerman on Oct 16, probably will be on surgery in two weeks for his catarat in his right eye.
    I am looking forward for your answer, please.

  4. I would try to answer some of the questions asked above.Pseudoexfoliation is a condition which has no treatment till now.It increases the chances of complications during cataract surgery.If glaucoma develops, get its treatment.

  5. Thank you for added info. I have this condition and am concerned about needed cataract surgery. A neuro surgeon told me that this condition does indeed increase risks during cataract surgery but that there are some things that can be done–sometimes a needed second surgery. Does not sound simple. I do not have glaucoma, but was told the two conditions often go hand in hand.

  6. I would like to know how serious the surgery is if complications occur after cateract surgery when one has this conditon. And also what kind of post operative care is needed if additional surgeries are necessary. Thank you


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