Postmortem microscopic evaluation and clinical correlation of a pseudophakic eye with pseudoexfoliation and loss of zonular support

We describe a pseudophakic patient with pseudoexfoliation who developed late intraocular lens (IOL) instability manifested by pseudophakodonesis, a change in refraction, and loss of glaucoma control. The patient subsequently required glaucoma surgery that was complicated by vitreous loss. Preoperative ultrasound biomicroscopy (UBM) failed to provide useful information regarding the zonular status. The patient died as a result of a malignancy, and the eye was donated for research. Anatomical evaluation confirmed the clinical impression of IOL placement in the bag and zonular laxity. Postmortem UBM helped explain some of the technical difficulties in examining zonules in the pseudophakic state.