Lens-based glaucoma surgery: using cataract surgery to reduce intraocular pressure

Area of Science:

• Ophthalmology
• Glaucoma Research
• Surgical Innovation

Background:

• Glaucoma management often involves lowering intraocular pressure (IOP).
• Cataract surgery is increasingly recognized for its IOP-lowering effects.

Purpose of the Study:

• To evaluate the efficacy of cataract surgery in reducing IOP in glaucoma patients.
• To compare cataract surgery with other glaucoma treatments like laser iridotomy and phacotrabeculectomy.
• To explore the role of clear lens extraction in managing acute glaucoma attacks and uncontrolled IOP.

Main Methods:

• Review of randomized controlled trials (RCTs) comparing cataract surgery to other interventions.
• Analysis of studies stratifying open-angle glaucoma (OAG) patients by preoperative IOP.
• Investigation of combined phaco-plus procedures (cataract surgery with microinvasive glaucoma surgery).

Main Results:

• Strong evidence supports cataract surgery in reducing IOP and preventing spikes in angle-closure glaucoma.
• RCTs suggest cataract surgery may be superior to laser iridotomy or phacotrabeculectomy.
• Significant IOP reduction (up to 8.5 mm Hg) observed in OAG patients with high preoperative IOP, though some studies have methodological criticisms.
• Phaco-plus procedures offer additional lens-based surgical options for glaucoma.

Conclusions:

• Cataract surgery is a viable option for lowering IOP in various glaucoma types.
• Its role in open-angle glaucoma requires further investigation, particularly regarding methodological rigor.
• Lens-based surgical approaches, including combined procedures, are expanding treatment possibilities for glaucoma.