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Severity of glaucoma key to choosing surgical approach
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WAIKOLOA, Hawaii — Choosing a surgical option for the patient with both glaucoma and cataract depends on the type and severity of glaucoma, according to a presenter here.
Options are cataract surgery alone, a combined phacoemulsification and glaucoma procedure, or a two-stage surgery, with either the glaucoma procedure first and then the cataract extraction later or the cataract extraction first and the glaucoma procedure, if necessary, later.
Brian A. Francis
When IOP is well controlled using one to two medications, then cataract surgery alone may be appropriate, Brian A. Francis, MD, said at Hawaiian Eye 2013.
“You can use laser trabeculectomy as an adjunct postoperatively, but if you do it preoperatively, you don’t get the pressure reduction you see from cataract surgery alone,” Francis said.
Combined surgery is more appropriate for patients with moderate to severe disease, Francis said, that is, for patients with uncontrolled IOP or with IOP controlled on three or more medications and with moderate to severe optic nerve or visual field damage.
When a phacotrabeculectomy is done, Francis recommends using a two-site incision with mitomycin C.
“Bleb failure is possible with a combined or a staged procedure,” he said.
Glaucoma surgeons have at least three things in their repertoire: microinvasive glaucoma surgery, trabeculectomy and tube shunt, Francis said.
“In mild glaucoma, consider cataract extraction alone. In mild to moderate, consider newer microinvasive procedures, and in severe glaucoma, consider combined trabeculectomy and cataract extraction,” Francis said.
Disclosure: Francis is on the medical advisory board for NeoMedix and Endo Optiks.