Preop factors important in successful combined phaco/glaucoma drainage device surgery, clinician says

SAN FRANCISCO — Preoperative considerations, such as selecting the best quadrant for implantation, treating inflammation and determining pupil size, can assist in achieving good outcomes in combined phacoemulsification and glaucoma drainage device implantation surgery, Vital P. Costa, MD, said here.

"In patients with refractory glaucomas, with previously failed trabeculectomies, extensive conjunctival scarring and bleb-related complications, glaucoma drainage devices may be indicated as the best approach to reduce intraocular pressure," he said at the Glaucoma Subspecialty Day prior to the American Academy of Ophthalmology meeting.

For those patients, careful consideration of preoperative factors can help enhance surgical results, he said. In cases with scleral thinning, conjunctival scarring or peripheral anterior synechiae, the inferonasal quadrant implantation site can be selected instead of the superotemporal quadrant, he said.

For uveitic and neovascular glaucoma cases with inflammation, Dr. Costa recommended preop topical steroids for reduction of postoperative inflammation.

Assessing preop pupil size is important because small pupils are associated with increased risk of complications after phaco, Dr. Costa said. Pupil stretching and iris hooks can assist during surgery, he said.