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Cataract surgery a potential management strategy in patients with early to moderate glaucoma
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KIAWAH ISLAND, S.C. — Cataract surgery alone may be a reasonable option for managing pressure in early- to moderate-stage glaucoma, according to a speaker here.
 Thomas W. Samuelson |
Common practice has been to delay cataract removal in glaucoma patients, especially in patients with exfoliation syndrome, Thomas W. Samuelson, MD, said at Kiawah Eye 2010. However, evidence is emerging that the lens may exacerbate glaucoma and, thus, retention of the lens may increase the need for glaucoma surgery, he said.
"Cataract extraction may alter the tone of the trabecular beams resulting in improved outflow facility," Dr. Samuelson said.
Treatment of glaucoma is an incremental process with one intervention introduced at a time. Along the continuum of treatments, Dr. Samuelson said, cataract removal should be considered after medication, laser trabeculectomy, canaloplasty (iScience Interventional), Trabectome (NeoMedix) and endoscopic laser.
"Once you bypass the trabecular meshwork, cataract removal is no longer the patient's friend," Dr. Samuelson said. "They are no longer dependent on their trabecular meshwork for outflow."
In patients with cataract and glaucoma, the debate has often been whether to perform a two-staged procedure or to do a combined cataract and glaucoma surgery. Both surgical procedures provide a separate benefit to the patient, namely, improved vision and lowering the IOP.
However, the new and emerging focus appears to be doing a single procedure focused on lens surgery as a means of lowering eye pressure in patients with early to moderate glaucoma. There is increasing evidence that the aging, cataractous lens acts as a “space-occupying-lesion,” causing mechanical, anterior displacement of the iris resulting in compromised trabecular outflow. Hence, performing a single procedure, namely, removal of the cataract alone provides the double benefit of improved vision and lowering IOP. As Dr. Samuelson cautions, this will usually work only when the trabecular meshwork is not bypassed. Continued clinical studies will only underscore this new and emerging concept.
– Thomas John, MD
OSN Cornea/External
Disease Board Member
References:
- Poley BJ, Lindstrom RL, Samuelson TW, Schulze Jr RR. Phacoemulsification with artificial lens implantation: A technique for prevention and treatment of adult glaucoma. Techniques in Ophthalmology (In Press).
- Rosdahl JA, Chen TC. Combined cataract and glaucoma surgeries: traditional and new combinations. Int Ophthalmol Clin. 2010;50:95-106.
- Shrivastava A, Singh K. The effect of cataract extraction on intraocular pressure. Curr Opin Ophthalmol. 2010;21:118-22.
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