Cataract surgery may be best glaucoma surgery, expert says

NAPLES, Italy — Cataract extraction alone may be the best and most appropriate procedure for patients with controlled or moderately uncontrolled glaucoma, according to one surgeon.

"About 10% of the patients who are referred to an ophthalmologist for age-related cataract also have glaucoma," OSN Global Chief Medical Editor Richard L. Lindstrom, MD, said here at the joint meeting of Ocular Surgery News and the Italian Society of Ophthalmology. "However, in the past 7 years, I haven't done a single combined procedure, and in most cases, cataract surgery had the positive consequence of lowering IOP to normal levels."

Does the lens play a more significant role in the development of glaucoma than previously recognized? The answer, according to Dr. Lindstrom, is yes.

The aging lens enlarges in both the axial and equatorial meridian, while the eye itself remains stable after the age of approximately 24 years. The increased volume of the lens may crowd the anterior chamber angle and prevent normal aqueous outflow.

"When you remove the lens and implant an IOL, the zonular fibers are stretched like in a younger eye, the trabeculum regains tone, the angle is freed, and this results in improved outflow facility," Dr. Lindstrom said.

In a retrospective review of 588 eyes that underwent cataract extraction with IOL implantation, a reduction of IOP was observed in most cases, particularly in the group of patients with higher preoperative IOP levels.

"In the group of patients with IOP between 23 mm Hg and 31 mm Hg, we had a mean decrease of 7 mm Hg," Dr. Lindstrom noted.

In most cases, cataract surgery may be the best glaucoma surgery and may lead to a reduction or elimination of medications. Severe glaucoma cases may an exception, Dr. Lindstrom said, and in these cases, combined procedures make sense.