Cataract and Glaucoma Surgery For Best Outcomes

Dear Readers, to tell you about myself before you delve into this Linkedin Article - I have been treating Glaucoma patients and meeting their families for the past 32 years. I am the immediate past Honorary General Secretary of the Glaucoma Society of India and the only one in that capacity from East India since the glorious 32 years of existence of the Glaucoma Society of India. Based on my experience I have penned down my thoughts on how one can get the best outcomes from Cataract and Glaucoma Surgery.?

Cataract (when the eye's naturally clear lens becomes cloudy) and Glaucoma (when eye pressure inside the eye rises and damages the optic nerve) are two of the most common eye diseases in the world. If a cataract makes it harder to see clearly, and ?eye pressure is high with optic nerve and or visual field damage, we may suggest treating both at the same time.

When to have combined cataract surgery and glaucoma surgery

To find out what treatment is right for you, your ophthalmologist will examine your eyes, to assess the following:

• your current glaucoma treatment and whether it lowers your eye pressure enough
• whether you are tolerating the side effects and expense of your glaucoma medications, and
• whether your cataracts keep you from doing your daily activities

Your ophthalmologist will suggest a treatment that gives you the best chance for better vision with the least amount of risk.

If doing glaucoma surgery and cataract surgery is required for you, your ophthalmologist will choose which type of combined surgery to do.

Cataract surgery and trabeculectomy(glaucoma filtration surgery)

For those with more advanced or poorly controlled glaucoma,? a trabeculectomy with cataract surgery may lead to lower eye pressure. Your ophthalmologist will remove your eye’s cloudy lens and replaces it with an artificial one. During the trabeculectomy, your Eye surgeon will make a flap, in the white of your eye. Through this flap a tiny opening is made into the eye. And through this opening and underneath the flap, the excess fluid drains into a pocket, called a bleb, which forms underneath the thin layer covering the white of the eye.. This excess fluid that drains out of the eye through the flap and into the bleb, is absorbed naturally by the body, resulting in lowering of eye pressure.

Cataract surgery and glaucoma drainage devices

In this surgery, your ophthalmologist will remove your eye’s cloudy lens and replace it with an artificial one. To help lower your eye pressure, She/He will put a tiny, plastic tube attached to a shunt/valve (plastic plate) into your eye, and place the plastic plate on the eye wall under the thin, clear membrane covering the white of your eye. The shunt/valve sends blocked fluid inside the eye to a this small, plastic plate, where the fluid is absorbed by blood vessels nearby. This helps lower eye pressure.

Cataract surgery and MIGS

Presently there are several newer glaucoma procedures that do not require as much cutting into the eye and may involve less risk than traditional glaucoma surgeries (trabeculectomy and shunts/valves). These are called MIGS, or micro-invasive or minimally invasive glaucoma surgeries. These surgeries can be combined with cataract surgery for patients with mild to moderate open-angle glaucoma. And most of them use the same incision, or small cut, that is used to remove the cataract. Most MIGS procedures move the trapped fluid from the eye by removing the blockage or bypassing it with a small tube or stent. These procedures lower eye pressure and may help to reduce the number of medications used.

Reasons to suggest a MIGS at the time of cataract surgery:

• to lower eye pressure. MIGS may provide better pressure control now and in the future.
• to take fewer medications. Patients may be able to decrease or stop taking anti glaucoma medications.? It is cumbersome to use eye drops regularly for long.

Reasons to suggest combined surgery:

• Easier for the patient: One visit to the operating room is more convenient and less stressful than two surgeries.
• Eye pressure remains stable after surgery: Sometimes eye pressure rises suddenly after cataract surgery. With the addition of glaucoma surgery, this usually does not happen.
• Lower cost: Two surgeries in single sitting is less expensive. If the glaucoma surgery is successful,? money saved by not needing as much or any anti glaucoma medicine.

Combined cataract and glaucoma surgery needs judicious selection:

• Sometimes the cataract is not causing any vision problems, but the glaucoma needs surgery. In such cases, it is best to do the glaucoma surgery and delay cataract surgery until later.
• In cases where glaucoma is well-controlled with medication, but cataracts are limiting vision-cataract surgery alone or cataract surgery with MIGS may be the? option of choice.
• Some patients have cataract with angle closure glaucoma. In this type of glaucoma, the iris (coloured part of the eye) is pushed too far forward, blocking fluid from leaving the eye, which raises the eye pressure. A cataract can make this type of glaucoma worse. Early cataract removal, may lower the eye pressure.?