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Combined procedures: the classic teaching now obsolete

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NEW YORK — Combined procedures work, and the classic teaching of performing trabeculectomy first and cataract extraction later has become obsolete, according to one glaucoma specialist.

Thomas W. Samuelson, MD, who spoke here at the Eleventh Annual Ocular Surgery News New York Symposium on Cataract, Glaucoma, Retina and Refractive Surgery, said that one of the many significant advantages of a combined procedure is the opportunity to eliminate compliance issues.

Other advantages: In a combined procedure, the patient should attain both lower intraocular pressure and improved visual acuity. Also, the use of medications can be eliminated or reduced, and there are fewer IOP spikes following a combined procedure, Dr. Samuelson said.

Disadvantages to a combined procedure do exist, Dr. Samuelson said. With the combined procedure there is risk of hypotony and an increased risk of blebitis, endophthalmitis and dysesthesia. The combined procedure also is more invasive than trabeculectomy alone, Dr. Samuelson explained.