Combined cataract and glaucoma surgery

Abstract

Cataracts and glaucoma commonly co‐exist, largely due to both being associated with older age. The crystalline lens can however cause glaucoma by phacomorphic or phacolytic processes, or by contributing to pupil block leading to primary angle closure. Medical and surgical treatments for glaucoma can also result in accelerated cataract formation. Cataract surgery in patients with glaucoma provides an opportunity to reduce medication burden and improve intraocular pressure control but has a higher risk than surgery in non‐glaucomatous eyes. Special consideration should be given to those with pseudoexfoliation (e.g. zonular instability), advanced glaucoma (e.g., risk of pressure spike and wipe out) or in those with short axial length or angle closure (e.g., shallow anterior chamber and risk of malignant glaucoma). Cataract surgery in eyes with previous subconjunctival glaucoma surgery is a particular challenge as it increases the risk of wound healing and failure of the filtering procedure. This presentation will outline steps for success in cataract surgery in patients with glaucoma and will also present recent evidence regarding the efficacy of phacoemulsification combined with minimally invasive glaucoma surgery (MIGS).