Surgical strategies in patients with cataract and glaucoma

Abstract

The surgical strategy decision must be customized to every patient. Only filtering surgeries are recommended in glaucoma patients with incipient cataract. Combined surgical procedures are recommended for progressive or advanced glaucoma. Two-site phacotrabeculectomy with mitomycin C achieves better stabilized results; however, combined phacoemulsification with deep sclerectomy or viscocanalostomy achieves similar results with a lower rate of complications. These promising findings need more study to be confirmed.

Corneal endothelial cell loss after trabeculectomy or after phacoemulsification, IOL implantation and trabeculectomy in 1 or 2 steps

“…While some authors prefer to first operate the cataract and continue medical treatment, others choose to carry out trabeculectomy and months later remove the cataract, whilst others are in favour of combined surgery [40][41][42][43]. Nevertheless, when glaucoma surgery is indicated, it is not clear whether it is better to perform the one-or two-step procedure.…”

“…However, other authors have documented that when cataract surgery is performed in a second step, the success of the previous trabeculectomy may be compromised [42], and advocate one-step surgery. On the other hand, some authors have documented that the onestep surgery may be as successful as trabeculectomy alone [40,43], and recommend this procedure for advanced glaucoma. We have had good results with the one-step technique: we have achieved intraocular pressure control (not shown), while producing less damage to the endothelium than with the two-step technique, and thus we indicate one-step surgery more frequently now.…”

Phacoemulsification in patients with Baerveldt tube shunts

“…Studies of cataract surgery in eyes with functioning filtration blebs suggest a trend toward decreased bleb function and poorer long-term control of intraocular pressure (IOP). [1][2][3] Recent studies, 4 however, indicate that smallincision phacoemulsification may not alter long-term IOP control or increase complication rates in eyes with functioning filtration blebs.…”

Are There Problems with Non-penetrating Glaucoma Surgery?

“…[33][34][35][36] Perhaps excessive inflammation generated during phacotrabeculectomy leads to increased probability of surgical failure.…”