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Abstract #19216 Published in IGR 3-1
Surgical indications in coexisting cataracts and glaucoma
Collignon-Brach JD; Ravet O; Robe-Collignon NJBulletin de la Société Belge d'Ophtalmologie 2000; 11-36
Cataract surgery in glaucoma patients is still a controversial subject. Indication of surgery depends on a lot of clinical parameters: diagnosis, state, evolution of glaucoma, as well as compliance with medical treatment, surgical procedures for cataract and glaucoma, sites of the surgery, use of antifibrosis agents and experience of the surgeon. Since cataract extraction alone decreases the intraocular pressure in open-angle glaucoma, and usually in uncomplicated closed-angle glaucoma and trabeculectomy alone reduces the intraocular pressure more than combined surgery, with less complications, the authors recommended the following surgical options: cataract extraction alone in patients with controlled open-angle glaucoma and in patients with closed-angle glaucoma; a two-step procedure: filtering surgery followed by cataract extraction in patients with poorly controlled open-angle glaucoma or mixed closed-angle glaucoma; ambulatory surgery and topical anesthesia permit two-stage surgery with less problems; a combined procedure in patients with chronic closed-angle glaucoma where a filtering procedure alone is associated with serious complications. In fact, the best surgical cataract procedure is phacoemulsification with a small supero-corneal incision and implantation of a foldable intraocular lens. The best filtering procedure is still trabeculectomy, or the new nonpenetrating trabecular surgery for experimented surgeons, in the superior quadrant. In the future, new surgical procedures and safe and nontoxic pharmacological drugs, which will modulate wound healing, will hopefully be found in order to increase the efficacy and indications of combined surgery. LA: French
Dr J.D. Collignon-Brach, Centre Hospitalier Universitaire Service d'Ophtalmologie, UnitéGlaucome Domaine du Sart Tilman, B-4000 LiÞge, Belgium
Classification:
12.12.3 Phacoemulsification (Part of: 12 Surgical treatment > 12.12 Cataract extraction)
