Anurag Shrivastava1, Kuldev Singh. 1. aDepartment of Ophthalmology, Glaucoma Service, Albert Einstein COM, Montefiore Medical Center, Bronx, New York bDepartment of Ophthalmology, Glaucoma Service, Stanford University, Stanford, California, USA.
Abstract
PURPOSE OF REVIEW: To summarize the effects of cataract surgery on the management of glaucoma, in terms of the effect on both the intraocular pressure (IOP) and postoperative diagnostic as well as therapeutic considerations. RECENT FINDINGS: Recent evidence corroborates prior data demonstrating significant and sustained IOP reduction after cataract extraction, particularly in closed-angle variants of glaucoma, but also in individuals with open-angle glaucoma or ocular hypertension. Performing cataract surgery after trabeculectomy increases the odds of filtration failure with the likelihood of this adverse effect being inversely proportional to the duration between the glaucoma and cataract procedures. Although cataract has a significant effect on the results of visual field testing, the Visual Field Index may be less influenced than other parameters such as the mean and pattern deviation. The accuracy of time-domain ocular coherence tomography and spectral-domain ocular coherence tomography are also negatively impacted by cataract. SUMMARY: Considering cataract surgery as an IOP-lowering procedure may be appropriate in select patients. Performing cataract extraction prior to glaucoma surgery has numerous benefits. The sequence of the procedures performed has implications in terms of complications, surgical success, and diagnostics. Reestablishing perimetric and structural baselines with imaging modalities is appropriate after cataract surgery is performed in glaucoma patients.
PURPOSE OF REVIEW: To summarize the effects of cataract surgery on the management of glaucoma, in terms of the effect on both the intraocular pressure (IOP) and postoperative diagnostic as well as therapeutic considerations. RECENT FINDINGS: Recent evidence corroborates prior data demonstrating significant and sustained IOP reduction after cataract extraction, particularly in closed-angle variants of glaucoma, but also in individuals with open-angle glaucoma or ocular hypertension. Performing cataract surgery after trabeculectomy increases the odds of filtration failure with the likelihood of this adverse effect being inversely proportional to the duration between the glaucoma and cataract procedures. Although cataract has a significant effect on the results of visual field testing, the Visual Field Index may be less influenced than other parameters such as the mean and pattern deviation. The accuracy of time-domain ocular coherence tomography and spectral-domain ocular coherence tomography are also negatively impacted by cataract. SUMMARY: Considering cataract surgery as an IOP-lowering procedure may be appropriate in select patients. Performing cataract extraction prior to glaucoma surgery has numerous benefits. The sequence of the procedures performed has implications in terms of complications, surgical success, and diagnostics. Reestablishing perimetric and structural baselines with imaging modalities is appropriate after cataract surgery is performed in glaucomapatients.