Can a glaucoma patient undergo cataract surgery?

If a glaucoma patient has cataracts, cataract surgery should definitely be performed, and it should be done early. However, since both glaucoma and cataracts include many subgroups, this topic needs to be addressed from several angles. As is known, there are two types of glaucoma: open-angle and closed-angle. Additionally, these two main types have many subgroups. Let's examine these groups one by one.

Can Cataract Surgery Be Performed on Open-Angle Glaucoma? When Should It Be Done?

If open-angle glaucoma is under control and the patient has a vision reduction due to cataracts, the generally accepted practice is to remove the cataract when vision decreases to around 60% with glasses.

Moreover, in exfoliation glaucoma, a hereditary type of glaucoma common in our country, cataract surgery should be performed early even if vision has not decreased to 60%. If the cataract is not removed and becomes harder, the risk of complications during cataract surgery increases in these patients.

Can Cataract Surgery Be Performed on Closed-Angle Glaucoma? When Should It Be Done?

In closed-angle glaucoma, where the front chamber of the eye is narrow and the angle between the iris and cornea is tight, the first step should be creating a hole in the iris using a laser. This procedure prevents sudden increases in eye pressure.

If there is a cataract, it is already beneficial to remove it early because the energy released while dissolving a hardened cataract can cause more damage in the already narrow front chamber.

Additionally, in eyes with narrow angles, cataract surgery can be performed very early to prevent pressure increases and delay complete angle closure, thus deepening and widening the anterior chamber by 2-3 times.

How Does Cataract Surgery Affect Eye Pressure?

In open-angle eyes, eye pressure generally decreases due to the vacuum and expanded angle during cataract surgery. In some patients, this can reduce the need for glaucoma medications and even eliminate the necessity for glaucoma surgery if needed. However, this reduction lasts about 2-3 years, so glaucoma patients who have had cataract surgery should continue regular glaucoma check-ups.

What Are the Benefits of Cataract Surgery for Glaucoma Patients?

• The patient's vision level and quality improve.
• Eye pressure decreases for a few years in most patients.
• Early cataract surgery reduces the risk of complications in patients with exfoliation glaucoma.
• The glaucoma doctor can take higher quality optic nerve and macular OCTs.
• The reliability of visual field tests increases.
• The angle widens in eyes with narrow angles, reducing the likelihood of angle closure.
• If glaucoma surgery is needed in the future, the risks of this surgery significantly decrease.
• Cataract accelerates in eyes that have undergone glaucoma surgery, and removing the cataract can reduce the success of glaucoma surgery.
• For all these reasons, it is beneficial to remove the cataract early if it has started in patients with glaucoma.

What Should Be Considered During Cataract Surgery in Glaucoma Patients?

Firstly, the surgeon's experience with such eyes is very important. During surgery in glaucoma eyes, a significant increase in eye pressure should be prevented.

In narrow-angle eyes, eye pressure should be initially lowered with special serums.

If there is a previous glaucoma surgery, the surgery site should be preserved. In patients whose pupils do not dilate well, mechanical devices and hooks should be used to enlarge the pupil. In eyes with exfoliation glaucoma with weak zonules, a capsular tension ring, a special device, should be placed in the eye.

What Should Be Considered After Cataract Surgery in Glaucoma Patients?

Unless otherwise specified by their doctor, patients should continue using eye pressure drops without interruption after surgery. My personal practice is to continue the preoperative medications for 2 months and, if the eye pressure has decreased somewhat thanks to the surgery, to reduce the eye pressure medications in the second month and repeat a detailed glaucoma examination and tests in the third month.

In conclusion, cataract surgery should be performed earlier in glaucoma patients compared to normal eyes. Early cataract removal facilitates the diagnosis, follow-up, and treatment of glaucoma, while also reducing the risks of cataract surgery.

Which type of intraocular lens should be implanted in eyes with glaucoma is a very important and lengthy question that needs to be answered separately. You can reach our article on this topic by clicking on the "Which type of lens is implanted during cataract surgery in eyes with glaucoma?" link.