In the daily practice of an ophthalmic surgeon, up to 20 percent of patients with cataract have increased intraocular pressure (IOP) and/or glaucoma. The reason for such a combination is found in the common mechanisms of these two diseases, which are directly associated with ageing and co-morbidities.
Glaucoma is often treated with eye drops, especially in cases of early disease. Eventually, it is necessary to select new drugs, as well as combine them, to achieve the desired effect. If the glaucoma advances, the surgical option comes into play.
Different laser or surgical procedures can also be done during the early stages of glaucoma. Several studies have demonstrated that early intervention better helps preserve vision and has a long-lasting effect. The current consensus is that there is no reason to delay surgical treatment for long.
For the patient with both cataract and glaucoma, several options are available. One is to separate the interventions and perform the glaucoma procedure first and then the cataract procedure, or vice versa. However, it’s becoming more common to combine microinvasive (minimally traumatic) glaucoma surgery (or MIGS) with microinvasive cataract surgery (MICS). Simultaneous cataract and glaucoma surgery is a well-proven solution for these two diseases, allowing the restoration of eye health, with minimal side effects, with one procedure.
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- Significant clouding of the natural lens.
- Insufficient effect of medical treatment for high intraocular pressure.
- Gradual loss of peripheral vision.
- Decreased quality of life due to low visual function.
- Very high intraocular pressure.
- General health issues such as diabetes, infections, blood clotting disorders, etc.
Combined cataract and glaucoma surgery consist of minimally invasive procedures: the most up-to-date technology of cataract removal, ultrasonic phacoemulsification, is combined with the sophisticated anti-glaucoma procedure. Some MIGS procedures involve implantation of a specific device such as a shunt or stent of various designs. There are many different combined techniques, all sharing the following steps:
- The cataract is removed.
- The intraocular lens is implanted into the capsular bag.
- The anti-glaucoma procedure is performed.
The specific technique to be used depends on the specific characteristics of the patient’s eye as well as the surgeon’s preferences. There is one major thing to keep in mind: the patient should not delay, but seek the ophthalmologist’s help in a timely manner.