Anterior Segment Changes Before and After Uneventful Combined Phaco-Trabeculectomy by Using Optical Coherence Tomography (OCT)

Definitions Glaucoma represents a group of diseases defined by a characteristic optic neuropathy that is consistent with excavation and undermining of the neural and connective tissue elements of the optic disc and by the eventual development of distinctive patterns of visual dysfunction .Pre-perimetric glaucoma is a term that is sometimes used to denote glaucomatous changes in the optic disc in patients with normal visual fields.

Glaucoma and cataract incidence increases with age. Special considerations are needed when choosing which surgical strategy to undertake when either of these two conditions requires surgical management. When performed prior to cataract surgery, trabeculectomy increases the risk of cataract formation by up to 78%, while subsequent cataract surgery may increase the risk of elevated intraocular pressure or trabeculectomy failure. By contrast, when cataract surgery alone is performed in glaucoma patients; an early postoperative intraocular pressure spike sometimes requiring medical treatment is commonly reported. Therefore, phacotrabeculectomy, a procedure that combines the management of these two conditions together in one surgery, may be considered in these situations.

When to Consider Combined Surgery

Combined cataract extraction and glaucoma surgery (trabeculectomy, glaucoma drainage implant surgery, or any of the newer surgical approaches for glaucoma) should be carefully selected and individualized depending on clinical findings in each case:

• Cataract surgery alone is sufficient for patients with well controlled in intraocular pressure in the setting of early to moderate optic nerve damage.
• Patients with uncontrolled intraocular pressure in the presence of severe optic nerve damage should receive glaucoma surgery first, followed by cataract extraction a few months later
• Combined surgery may be best suited for a patient with a visually significant cataract with uncontrolled glaucoma despite maximal medical therapy and/or laser trabeculoplasty. Cost is often an issue for many patients and eliminating medications can help reduce the financial burden. Poor compliance with glaucoma medications can also be an issue to consider both procedures together.