Background Pseudoexfoliation syndrome (PEX) is often complicated with cataract,accompanied by zonular defects.Zonular related complications easily happened intraoperatively and postoperatively.It is very important to choose the operating timing and method to reduce the complications and improve curative effects.However,relative study is rare.Objective This study was to analyze the curative effects of cataract extraction and intraocular lens (IOL) implantation for PEX combined cataract (PEXC) with zonular defect and discuss the appropriate operation timing and method.Methods A serial cases-observational study was performed,and written informed consent was obtained from each patient prior to ocular surgery.Twenty-three eyes of 21 patients with PEXC and zonular defect were included and received PEXC surgery in Second People's Hospital of Kashi from July 2012 to December 2015.The patients were divided into phacodonesis type (18 eyes) and subluxation of lens (5 eyes) based on the severity of zonular defect and grade Ⅱ (4 eyes),grade Ⅲ (9 eyes),grade Ⅳ (7 eyes) and grade Ⅴ (3 eyes) nuclei based on the hardness of lens nuclei.Phacoemulsification combined capsular tension ring (CTR) or modified CTR (MCTR) insertion and IOL implantation was carried out for grade Ⅱ and Ⅲ nuclei with phacodonesis eyes.or extracapsular cataract extraction combined CTR and IOL implantation was carried out for grade Ⅳ and Ⅴ nuclei with phacodonesis eyes,and phacoemulsification combined MCTR insertion and IOL implantation,or lens loop nucleusdeliver,anterior vitrectomy combined suspensory IOL implantation were performed for subluxation eyes.The patients were followed up for consecutive 3 months,and optimal operation timing,best corrected visual acuity (BCVA),intraocular pressure (IOP),complications and anterior capsular opening,IOL position were assessed.Results In the patients with phacodonesis,CTR was inserted in 10 eyes,and MCTR was inserted in 3 eyes,and extracapsular cataract extraction combined CTR and IOL implantation was carried out in 4 eyes and l eye received anterior vitrectomy combined suspensory IOL implantation.In the patient with subluxation of lens,only 1 eye finished successful phacoemulsification combined anterior vitrectomy and suspensory IOL implantation,and other 4 eyes received lens loop nucleus-deliver,anterior vitrectomy combined suspensory IOL implantation.The BCVA of the operated eyes was ＞0.5 in 4 eyes,＞0.3-≤0.5 in 6 eyes,＞0.1-≤0.3 in 8 eyes,≤0.1 in 5 eyes,which was better than that before surgery (X2 =17.29,P＜0.01).The IOP was (16.82 ±2.25) mmHg before surgery and reached (16.12±2.67) mmHg 3 months after surgery,with a significant difference between them (t=0.108,P＞0.05).The intra-and post-operative complications included small pupil,corneal edema,residual cortex and posterior capsular opacification.Conclusions The operative process of PEXC eyes with zonular defect is complex.The choice of operative time and methods depends upon the type of zonular defect,hardness of lens nuleus,with or without subluxation of lens.A carefully ocular examination before operation is crucial for the therapy of PEXC.

To investigate the safety and efficacy of capsular tension ring ( CTR ) insertion combined with phacoemulsification and intraocular lens ( lOL ) implantation in patient with pseudoexfoliation syndrome after anti-glaucoma surgery.
●METHODS: A retrospective study was conducted of 10 eyes from 10 cataract patients with pseudoexfoliation syndrome following trabeculectomy surgery, and who underwent CTR insertion combined with phacoemulsification and lOL implantation between January, 2012 and June, 2013. All cases had nuclear cataracts ( nuclear hardness Ⅱ 1 eye, nuclear hardnessⅢ 4 eyes, nuclear hardness Ⅳ 5 eyes). One case with Ⅳ nuclear hardness cataract had iridodonesis and lens subluxation. Postoperative visual acuity, intra- and post-operative complications, anterior capsular opening, lOL position, and postoperative intraocular pressure ( lOP) were assessed. Follow-ups ranged from 3 to 14mo. The t test was used to analyze the variables studied.
●RESULTS: All patients had a successful CTR insertion combined with phacoemulsification and lOL implantation. A modified CTR insertion was performed in one case, the others underwent a standard CTR insertion. The best corrected visual acuity ( BCVA) was≥0. 5 in 3 eyes and 0. 3-<0. 5 in 2 eyes. However, BCVA was ≤0. 1 in 5 eyes. No decentration and dislocation of lOL was found during follow - up. Optic atrophy of different level could be found in all cases. The mean lOP was 16. 78±2. 48mmHg before surgery. And the average lOP is 16. 01±2. 33mmHg at 3mo postoperative (t= 1. 9955, P>0. 05). The most common intrao- and post-operative complications were corneal edema, small pupil, residual cortex, spontaneous zonular dialysis.
● CONCLUSlON: Suitable CTR insertion in appropriate occasion may be beneficial to patients with pseudoexfoliation syndrome after trabeculectomy during cataract surgery. lt prevents the lOL decentration and decrease the surgical complication. Less complication occurs at the early stage.