Cataract Surgery Focus on Glaucoma

SEPTEMBER 2010 CATARACT & REFRACTIVE SURGERY TODAY 45 C ataract and glaucoma frequently occur in the same patient, especially as the world’s population ages. Studies have shown that cataract surgery alone is capable of modestly reducing IOP and minimizing the patient’s need for multiple eye drops to control his or her IOP.1 The decrease may be larger when the baseline pressure is higher. Many theories have been proposed to explain this effect in terms of anatomical and biochemical changes after cataract surgery. Questions remain as to the longevity of the reduction in IOP, its effect on diurnal pressure control, and how low the IOP can get. The ideal candidate for cataract surgery alone has a visually significant cataract, mild glaucoma, and an IOP that is controlled by less than maximally tolerated medical therapy. Surgeons usually decide to perform cataract surgery combined with a filtering procedure when patients have moderate or advanced glaucoma and/or uncontrolled IOP, but significantly greater risks of complications are to be expected. They include shallow chambers, hypotony, choroidal effusion, malignant glaucoma, bleb leaks, and infection.2 This article discusses a new option that may soon fit into this continuum: the iStent (Glaukos Corp., Laguna Hills, CA) combined with cataract surgery.