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Results show cataract surgery alone a good option for combined glaucoma and cataract cases
 Richard L. Lindstrom, MD |
KOLOA, Hawaii — For the general ophthalmologist, the best option for combined glaucoma and cataract patients is cataract surgery alone, a speaker here said.
Based on literature available and his own research, performing phacoemulsification and IOL implantation is a viably safe and effective option for significant IOP lowering, Richard L. Lindstrom, MD, said at Hawaiian Eye 2010.
"In patients with IOP greater than 25 mm Hg, one can achieve 10 mm Hg drops in IOP vs. 13 mm Hg for tube and trabeculectomy," Dr. Lindstrom said. As well, the complication rate in cataract surgery is 5% compared with 40% to 60% for tube and trabeculectomy.
Dr. Lindstrom added that cataract surgery is synergistic with medical therapy and is compatible with the surgical skill level of the comprehensive ophthalmologist.
Dr. Lindstrom cited a study presented at the American Academy of Ophthalmology meeting by his colleague Thomas W. Samuelson, MD, comparing cataract surgery alone and cataract surgery plus iStent implantation (Glaukos) in lowering IOP.
In the U.S. Food and Drug Administration PMA/IDE trial comparing cataract surgery alone vs. cataract surgery plus iStent, both groups achieved significantly lower IOP. However, at 1 year, twice as many patients in the phaco-alone group were back on medications as compared to phaco plus iStent. This study confirmed the IOP lowering effect of phaco alone, yet phaco plus iStent lowered IOP and reduced the medication burden of patients with early to moderate glaucoma.
"Cataract surgery should be considered an incremental step in glaucoma management," Dr. Lindstrom said.
Editor's note: This is an updated version of an article that appeared on the OSN SuperSite on Jan. 19, 2010.
Evidence continues to mount regarding the favorable effect of phacoemulsification on IOP in patients with moderately elevated IOP. The Glaukos PMA/IDE FDA trial may be the cleanest data to date demonstrating this effect. Both arms of this prospective randomized trial experienced an 8 mm Hg drop in IOP, although the phaco alone group required more postoperative medication than did the iStent group. It is important to note that only patients with early to moderate glaucoma were included in this study and patients with severe glaucoma were excluded. Therefore the results cannot be applied to patients with advanced disease.
– Thomas W. Samuelson, MD
OSN Glaucoma
Section Editor