Cataract Surgery in Glaucoma Patients

Pre-surgery care considerations

Some patients with glaucoma may be suffering from allergies to their glaucoma drops. Others may have inflammatory conditions that led to their glaucoma. It is crucial for this inflammation or allergy to be addressed and treated in advance of cataract surgery to prevent this inflammation from going out of control after the surgery and damaging vision.

Reducing risk of complications

Some patients who suffer from a type of glaucoma called pseudoexfoliation glaucoma may have very challenging cataracts and are at a higher risk of complications. A glaucoma surgeon would be fully aware of this condition in advance and would take the necessary steps to avoid complications.

Cataract surgery as part of the eye pressure management

In glaucoma patients, lowering eye pressure is the mainstay of treatment. Cataract surgery may impact eye pressure, and a glaucoma surgeon is fully aware of this and may use it to the patient’s advantage. Any cataract operation may provide a modest reduction in eye pressure. However, in some patients with high eye pressure because of narrow drainage channels, cataract surgery may be a treatment for them that can reduce intraocular pressure and arrest the glaucoma. This is because cataract surgery opens the drainage channels and may normalize eye pressure in these patients. Moreover, in some patients, a glaucoma surgeon may combine the cataract operation with minimally invasive procedures to help lower eye pressure even further. Examples of these procedures are the i-stent or the hydus stents that can be inserted during cataract surgery to help lower eye pressure in glaucoma patients.

Surgery aftercare

Glaucoma patients are more prone to developing very high eye pressure spikes in the first few hours after cataract surgery. Hence all glaucoma patients should have their eye pressures checked after cataract surgery and additional eye pressure-lowering medications if necessary.

Impact on previous surgeries

Some glaucoma patients may have had glaucoma operations such as trabeculectomies or preserflo. Cataract surgery causes inflammation which may be detrimental to these operations as it may cause them to scar and make the trabeculectomy or the preserflo less effective. Hence, all these patients should have their cataract surgery performed by a glaucoma specialist who would deliver special ant-scarring agents at the end of their surgery, monitor them closely in the post-operative period, and take steps if there are signs of scarring.

Replacement lenses for glaucoma patients

Finally, most patients who have glaucoma have a reduced contrast sensitivity which progresses as glaucoma deteriorates, i.e., they find it more difficult to discriminate between objects and find it more difficult to see at night. Moreover, most of these patients use a multitude of glaucoma drops, making their eye surface dry and more susceptible to glare. Multifocal lenses offered to some cataract patients and intended to provide vision improvement across various distances, also reduce contrast sensitivity and may cause glare. Hence the quality of vision in glaucoma patients may be impaired if one opts for these lenses, and as a rule, we advise patients who have glaucoma or are at risk of developing it to avoid multifocal lenses and opt for the standard monofocal lenses.