Posted on the PCON Supersite November 22, 2011

Cataract surgery gaining popularity as surgical option for glaucoma

NEW YORK — Cataract removal is a viable alternative to glaucoma surgery because of significant IOP reduction and enhanced safety, a clinician said here.

“Cataract surgery is getting more and more consideration as moving up the food chain there because of the risk-benefit,” Reay H. Brown, MD, said at OSN New York 2011. “The problem with glaucoma surgery … is too much risk.”

Cataract surgery is a good surgical option for open-angle glaucoma and an even better choice for angle-closure glaucoma, Dr. Brown said. In terms of risk-benefit analysis, cataract surgery is the optimal surgical treatment for glaucoma, he said.

Three-year results of the Tube Versus Trabeculectomy Study showed that complications occurred in 39% of eyes implanted with tubes and 60% of eyes that underwent trabeculectomy. Treatment failed in 31% of trabeculectomy eyes and 15% of tube eyes, Dr. Brown said.

The iStent Study conducted by Glaukos showed that cataract surgery alone reduced IOP by 8.4 mm Hg, and cataract surgery plus iStent insertion lowered IOP by 8.5 mm Hg.

Glaucoma surgery is the best option in cases involving high IOP, defined as 25 mm Hg to 30 mm Hg or higher, Dr. Brown said. Cataract surgery is ideal in cases involving narrow or closed angles, he said.

“Cataract surgery is not a trabeculectomy,” Dr. Brown said. “Don’t expect to lower the pressure if it’s in the high 20s or 30s down to 15. If you do, you’re going to be disappointed, and the patient is going to be unhappy and it’ll be just a mess.”