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Glaucoma specialist suggests early cataract surgery alone in patients with pseudoexfoliation

Issue: May 25, 2012

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CHICAGO – Cataract surgery done earlier rather than later, without a combined glaucoma procedure, is the approach one specialist takes to treating patients with pseudoexfoliation.

“I always try to avoid combining cataract surgery with glaucoma surgery,” Reay H. Brown, MD, said at the American Society of Cataract and Refractive Surgery annual meeting here. “Pseudoexfoliation cataract surgery is hard enough already, and cataract surgery should be done before glaucoma surgery. I’ve done more than 1,000 of these pseudoexfoliation cataract [surgeries], and I find it’s rare to need to do combined surgery and it’s rare to need urgent glaucoma surgery after cataract surgery.”

“The problem, of course, with glaucoma is risk,” Dr. Brown said, adding that all risks, for both glaucoma and cataract, are more common after combined surgery than for either surgery alone.

Another reason not to combine surgeries is that the opportunity to reduce IOP from cataract surgery alone would be missed. In one study by Bradley Shingleton, MD, and colleagues, IOP was effectively reduced in patients with pseudoexfoliation after cataract surgery alone, Dr. Brown said.

“The key is to remove the cataract as early as possible,” Dr. Brown said. “There are so many advantages to early surgery, because everything worsens with age and time.”

The cataract will be more dense, the dilation is reduced, the zonules are weaker, and the glaucoma is worse, he said. Even so, the patients should be monitored closely for vision changes that occur with rapid progression of cataract and for IOP spikes.  

• Dr. Brown has financial relationships with Allergan, GMP, Ivantis Inc., Merck and Rhein Medical.
• References: Shingleton BJ, Wooler KB, Bourne CL, O’Donoghue MW. Combined cataract and trabeculectomy surgery in eyes with pseudoexfoliation glaucoma. J Cataract Refract Surg. 2011;37(11):1961-1970.