Features of cataract surgery and the postoperative period in patients with glaucoma (part 1)

Abstract

The comorbidity of glaucoma and cataract occurs in up to 76 % of ophthalmic patients. The presence of glaucoma in these patients increases the risk of complications in cataract surgery by up to 51.6%. Small pupil occurs in 14 % of cases during cataract surgery, with frequency increasing with age, reaching 71% by the age of 80. Small pupil is a complicating factor in phacoemulsification in patients with glaucoma and can lead to undesirable visual outcomes. However, today the arsenal of ophthalmic surgeons has a number of iris retractors that dilate the pupil during the lens extraction, which makes the operation simpler. Weakness of the ligamentous apparatus of the lens occurs in one third of patients with glaucoma. Cataract surgery in these patients is accompanied by difficulties in performing classical capsulorhexis and a high risk of decentration or subluxation of the lens. Pupil rigidity, drug-induced miosis and ligamentous laxity require the use of iris retractors, capsular rings, and in some cases extracapsular fixation of the lens. Hemorrhagic complications of cataract surgery in patients with glaucoma manifest as hyphema and expulsive hemorrhages. Considering the specifics of ocular microcirculation, expulsive hemorrhage occurs during cataract surgery in 0.026–0.04 % of cases. The reason for this is the difference in pressure in the vascular bed and out-side of it. The higher the initial intraocular pressure during lens extraction, the higher the risk of hemorrhage. The conventional recommendation is maximum compensation of intraocular pressure before phacoemulsification.