July 29, 2015
Loose zonules complicate cataract surgery because their laxity makes removal of the nucleus and cortex challenging and limits stability of the IOL. In some patients we are able to detect zonular laxity during the preoperative consultation. Severe laxity may result in subluxation of the cataract or marked phacodonesis, in which the cataract is seen to move or shake in response to ocular movement. Patients with visible pseudoexfoliative material on the anterior lens capsule are also at higher risk for loose zonules. Other signs may be more subtle, such as a shallow anterior chamber in the presence of a normal axial length. This may occur because the loose zonules allow the entire lens-iris diaphragm to push forward and compress the anterior chamber. A more difficult situation is to detect the presence of zonular laxity once the cataract surgery has already begun.