Combined glaucoma/cataract surgery widely accepted option

BARCELONA, Spain — Combined cataract and glaucoma surgery has become increasingly accepted for management of eyes with both conditions, according to Karim F. Tomey, MD, FACS, FRCOphth, speaking here at the opening session of the International Glaucoma Symposium.

Dr. Tomey reviewed published studies on various methods of combining the two surgeries and the consequences of doing so. He said the effect of cataract surgery can either better or worsen IOP based upon such factors as the severity of the glaucoma and type of disease. Long-term IOP reduction typically resulted from combining the surgeries. Additional advantages can include immediate IOP control, immediate visual rehabilitation, reduction of IOP spikes and a better quality of life for the patient, he said.

Small pupil management, smaller cataract incision sizes, more successful methods by which to manage and improve bleb function and improved capabilities to modulate wound healing have all made the combined surgeries more palatable for both patient and surgeon, Dr. Tomey said.

Metabolites, such as 5-fluorouracil, do not improve IOP reduction, and only a small benefit of mitomycin-C (MMC) use has been established, he said. Of particular interest, MMC may significantly improve filtration surgery in blacks and patients in whom filtration has failed may benefit from MMC use.

Other variables to consider in combined surgery are limbus vs. fornix-based flaps. Limbus flaps are more difficult to dissect, provide poor exposure and are more associated with the possibility of buttonholes.

“On the other hand, once you manage to make these flaps successfully, they are usually easier to close,” Dr. Tomey said. “And the leakage, in general, is less common than with a fornix flap.”

Dr. Tomey also said phaco offers better pressure control, fast visual rehabilitation, less astigmatism and a decreased need for postoperative medications.