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New customized surgical approaches could benefit glaucoma patients with cataracts
WAIKOLOA, Hawaii — Advances in procedures and technology have greatly expanded surgical options for glaucoma patients with cataract, according to a speaker here.
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Robert J. Noecker, MD, MBA, spoke at Hawaiian Eye 2008 about various approaches to these challenging cases.
"This used to be a boring talk ... but things have gotten so much more interesting," thanks to the rapid evolution of both cataract and glaucoma surgical technology, Dr. Noecker said.
In general, he said, taking out the cataract in a glaucoma patient "is a very good thing to do." Removing the cataract can improve the visual field and facilitate imaging by eliminating the opacification, he said.
Dr. Noecker recommended topical clear cornea cataract surgery because it minimizes contact with the conjunctiva, reduces the possibility of scarring and preserves the possibility for future surgery.
Dr. Noecker said he prefers to perform the surgeries separately rather than in a combined procedure to better control astigmatism, IOL positioning, degree of inflammation and visual recovery.
If a combined procedure is chosen, however, numerous glaucoma technologies, including endoscopic cyclophotocoagulation, ExPress Minishunt (Optonol), Baerveldt (Advanced Medical Optics), Trabectome (NeoMedix) and canaloplasty, can work well in conjunction with phacoemulsification, he said.
"The nice thing is that we can customize now. We have all these options and we're moving away from the old gold standard," he said.