Cataract and glaucoma surgery

Abstract

Cataract and glaucoma are two of the leading causes of worldwide blindness, and as such they frequently coexist. When cataracts become visually significant and require surgery in a patient with concurrent glaucoma, three surgical options exist: performing cataract surgery alone; sequential surgery-performing glaucoma surgery first with the plan to perform cataract surgery at a later time; and lastly combined cataract and glaucoma surgery. Each of these options has its own set of advantages and disadvantages, and each one needs to be considered depending on the specific clinical scenario. Cataract extraction alone has been shown to decrease intraocular pressure and is a sufficient surgical option in many cases of open-angle and closed-angle glaucoma. Sequential surgery is most appropriate when the glaucoma is the dominant factor in the patient's clinical picture, and lowering the elevated intraocular pressure takes precedence over removing the cataract, which may not be visually significant at that time. Combined surgery is appropriate when the cataract is visually significant, and the glaucoma is either uncontrolled or controlled on maximally tolerated medical therapy. Several new glaucoma surgical procedures have recently become available; however, the gold standard for combined cataract/glaucoma surgery remains phacoemulsification with trabeculectomy.