a. What is the diagnosis?.

Answer
Pseudoexfoliation syndrome.
The surface of the lens shows pinkish deposits on intact lens capsule. 
The deposits have been described as resembling iron fillings on magnets. They also occur on iris and the ciliary body.

b. Does this type of patient need regular follow-up and why?.

Answer
Even if the intraocular pressure is normal at the time of diagnosis, 60% of patients develop open angle glaucoma in their life-time. This rise in the intraocular pressure can occur rapidly. Regular follow-up for intraocular pressure measurement is recommended.

Answer
Dandruff liked deposits on the pupil edge.
Peripupillary atrophy with iris transillumination.
Pigment deposits on the iris (Sampaolesi's line refers to pigment deposit at the level of Schwalbe's line on gonioscopy).
 
 

Answer
Two reasons:
a. The pupil dilates poorly.
b. The zonule is unstable, zonulysis and/or lens subluxation can occur during cataract extraction or during lens implantation .