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Phaco may reduce IOP in some glaucoma patients, surgeon says

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PHILADELPHIA — Cataract surgery can be an effective option for treating some patients with glaucoma, according to a glaucoma specialist speaking here.

Combined glaucoma and cataract surgery can reduce IOP with a success rate approaching that of filtering procedures, said Ike K. Ahmed, MD, FRCSC, of Toronto. He gave the Irving H. Leopold Lecture at the 2007 Wills Eye Hospital Annual Alumni Conference.

Dr. Ahmed cited a 1998 study by Gunning and Greve in the Journal of Cataract and Refractive Surgery that focused on phacoemulsification for chronic or subacute angle-closure glaucoma. Among 22 eyes treated with phacoemulsification and IOL implantation, 68% had controlled IOP. In comparison, 68% of 25 eyes treated with trabeculectomy had controlled IOP, but 15 eyes later required cataract removal, he said.

In the study, phacoemulsification reduced mean IOP from 21.4 mm Hg to 14.5 mm Hg. Also, 91.9% of patients had controlled IOP at 2 years follow-up, with 30% requiring no medication, Dr. Ahmed said.

Phacoemulsification may also be considered in cases of mild to moderate plateau iris syndrome that is controlled on fewer than three medications, he said, noting that preserving the conjunctiva is critical in these cases.

In addition, patients with small pupils can benefit from surgery involving the use of capsular tension rings to expand the capsular equator, bolster weak zonules and redistribute tension from existing zonules, Dr. Ahmed said.