Surgical goal determines procedure in combined cataract/glaucoma patients

The amount of visual disturbance, the target IOP and the amount of glaucomatous damage should be the main determinants when deciding on a surgical approach in patients with both cataract and glaucoma, a recent publication suggests.

C. Vass, MD, and R. Menapace, MD, reviewed the literature to compare surgical options for elderly patients with both glaucoma and cataract, based on achievable postoperative IOP levels and the rates of success and complications.

Phacotrabeculectomy combined with mitomycin C achieves the best IOP lowering of all types of combined cataract and glaucoma surgery currently possible, the authors found, but it is associated with potentially sight-threatening complications. In the absence of a low target pressure, phacotrabeculotomy or a combination of phaco with viscocanalostomy or deep sclerectomy may be the therapy of choice, they conclude.

The review is published in the January issue of Current Opinion in Ophthalmology.