Cataract and Glaucoma Surgery

  • Joseph R. Zelefsky
  • Stephen A. Obstbaum


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.


Anterior Chamber Cataract Surgery Cystoid Macular Edema Cataract Extraction Prostaglandin Analog 
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  1. 1.
    Jampel H, Friedman DS, Lubomski LH, et al. Effect of technique on intraocular pressure after combined cataract and glaucoma surgery. Ophthalmology. 2002;109:2215–24.PubMedCrossRefGoogle Scholar
  2. 2.
    Panchapakesan J, Mitchell P, Tumuluri K, Rochtchina E, Foran S, Cumming RG. Five year incidence of cataract surgery: the Blue Mountains Eye Study. Br J Ophthalmol. 2003;87(2):168–72.PubMedCrossRefGoogle Scholar
  3. 3.
    Krupin T, Feitl ME, Bishop KI. Postoperative intraocular pressure rise in open-angle glaucoma patients after cataract or combined cataract-filtration surgery. Ophthalmology. 1989;96:579–84.PubMedCrossRefGoogle Scholar
  4. 4.
    Levkovitch-Verbin H, Habot-Wilner Z, Burla N, et al. Intraocular pressure elevation within the first 24 hours after cataract surgery in patients with glaucoma or exfoliation syndrome. Ophthalmology. 2008;115:104–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Pohjalainen T, Vesti E, Uusitalo RJ, et al. Phacoemulsification and intraocular lens implantation in eyes with open-angle glaucoma. Acta Ophthalmol Scand. 2001;79:313–16.PubMedCrossRefGoogle Scholar
  6. 6.
    Tham CC, Chan JC. The clinical outcomes of cataract extraction by phacoemulsification in eyes with primary angle closure glaucoma (PACG) and coexisting cataract: a prospective case series. J Glaucoma. 2006;15(1):47–52.PubMedCrossRefGoogle Scholar
  7. 7.
    Hayashi K, Hayashi H, Nakao F, et al. Effect of cataract surgery on intraocular pressure control in glaucoma patients. J Cataract Refract Surg. 2001;27(11):1779–86.PubMedCrossRefGoogle Scholar
  8. 8.
    Vizerri G, Weinreb RN. Cataract surgery and glaucoma. Curr Opin Ophthalmol. 2010;21(1):20–4.CrossRefGoogle Scholar
  9. 9.
    Husain R, Gazzard G, Aung T, et al. Initial management of acute primary angle closure: a randomized trial comparing phacoemulsification with laser peripheral iridotomy. Ophthalmology. 2012;119(11):2274–81.PubMedCrossRefGoogle Scholar
  10. 10.
    Brown SV, Thomas JV, Budenz DL, Bellows AR, Simmons RJ. Effect of cataract surgery on intraocular pressure reduction obtained with laser trabeculoplasty. Am J Ophthalmol. 1985;100(3):373–6.PubMedGoogle Scholar
  11. 11.
    Tennen DG, Masket S. Short and long-term effect of clear corneal incision on intraocular pressure. J Cataract Refract Surg. 1996;22:568–70.PubMedCrossRefGoogle Scholar
  12. 12.
    Tong JT, Miller KM. Intraocular pressure change after sutureless phacoemulsification and foldable posterior chamber lens implantation. J Cataract Refract Surg. 1998;24:256–62.PubMedCrossRefGoogle Scholar
  13. 13.
    Shingleton BJ, Gamell LS, O’Donoghue MW. Long-term changes in intraocular pressure after clear corneal phacoemulsification: normal patients versus glaucoma suspect and glaucoma patients. J Cataract Refract Surg. 1999;25:885–90.PubMedCrossRefGoogle Scholar
  14. 14.
    Shingleton BJ, Pasternak JJ, Hung JW, et al. Three and five year changes in intraocular pressures after clear corneal phacoemulsification in open angle glaucoma patients, glaucoma suspects, and normal patients. J Glaucoma. 2006;15:494–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Kass MA. Cataract extraction in an eye with filtering bleb. Ophthalmology. 1982;89:871–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Rebolleda G, Munoz-Negrete FJ. Phacoemulsification in eyes with functioning filtering blebs: a prospective study. Ophthalmology. 2002;109(12):2248–55.PubMedCrossRefGoogle Scholar
  17. 17.
    Hopkins JJ, Apel A, Trope GE, et al. Early intraocular pressure after phacoemulsification combined with trabeculectomy. Ophthalmic Surg Lasers. 1998;29:273–9.PubMedGoogle Scholar
  18. 18.
    Cotran PR, Roh S, McGwin G. Randomized comparison of 1-site and 2-site phacotrabeculectomy with 3-year follow-up. Ophthalmology. 2008;115:447–54.PubMedCrossRefGoogle Scholar
  19. 19.
    Weitzman M, Caprioli J. Temporal corneal phacoemulsification with separate-incision superior trabeculectomy. Ophthalmic Surg. 1995;26:271–3.PubMedGoogle Scholar
  20. 20.
    Fine IH, Hoffman RS, Packer M. Profile of clear corneal cataract incisions demonstrated by ocular coherence tomography. J Cataract Refract Surg. 2007;33:94–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Bateman DN, Clark R, Azuara-Blanco A, et al. The effects of new topical treatments on management of glaucoma in Scotland: an examination of ophthalmological health care. Br J Ophthalmol. 2002;86:551–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Strutton DR, Walt JG. Trends in glaucoma surgery before and after the introduction of new topical glaucoma pharmacotherapies. J Glaucoma. 2004;13(3):221–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Damji KF, Shah KC, Rock WJ, et al. Selective laser trabeculoplasty v argon laser trabeculoplasty: a prospective randomised clinical trial. Br J Ophthalmol. 1999;83(6):718–22.PubMedCrossRefGoogle Scholar
  24. 24.
    Martinez-de-la-Casa JM, Garcia-Feijoo J, Castillo A, et al. Selective vs argon laser trabeculoplasty: hypotensive efficacy, anterior chamber inflammation, and postoperative pain. Eye. 2004;18(5):498–502.PubMedCrossRefGoogle Scholar
  25. 25.
    O’Brien TP. Emerging guidelines for use of NSAID therapy to optimize cataract surgery patient care. Curr Med Res Opin. 2005;21(7):1131–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Oetting TA, Omphroy LC. Modified technique using flexible iris retractors in clear corneal cataract surgery. J Cataract Refract Surg. 2002;28:596–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Akman A, Yilmaz G, Oto S, et al. Comparison of various pupil dilatation methods for phacoemulsification in eyes with a small pupil secondary to pseudoexfoliation. Ophthalmology. 2004;111:1693–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Miyake K, Ota I, Maekuba K, et al. Latanoprost accelerates disruption of the blood-aqueous barrier and the incidence of angiographic cystoid macular edema in early postoperative pseudophakias. Arch Ophthalmol. 1999;117:34–40.PubMedCrossRefGoogle Scholar
  29. 29.
    Miyake K, Ota I, Ibaraki N, et al. Enhanced disruption of the blood–aqueous barrier and the incidence of angiographic cystoid macular edema by topical timolol and its preservative in early postoperative pseudophakia. Arch Ophthalmol. 2001;119:387–94.PubMedCrossRefGoogle Scholar
  30. 30.
    Arcieri ES, Santana A, Rocha FN, et al. Blood-aqueous barrier changes after the use of prostaglandin analogues in patients pseudophakia or aphakia. Arch Ophthalmol. 2005;123:186–92.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of OphthalmologyAlbert Einstein College of MedicineBronxUSA
  2. 2.Department of OphthalmologyLenox Hill HospitalNew YorkUSA

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