Phacoemulsification in Eyes with Prior Glaucoma Surgery: Problems and Solutions

Abstract

Glaucoma and cataract remain the leading causes of vision loss and blindness in Russia and worldwide. When these conditions coexist, sequential glaucoma surgery and phacoemulsification (PE) are often required. However, cataract extraction poses a threat to the long-term functionality of successful bleb. This is due to a local inflammatory reaction and scarring in the filtering bleb area, initiated by surgical trauma during PE. According to existing studies, PE leads to failed glaucoma surgery in most cases; however, quantitative assessments of intraocular pressure decompensation can vary significantly between studies. Optical coherence tomography of the filtration bleb after PE demonstrates its degeneration — a decrease in size and growth of hyperreflective tissue. Limited data on femtosecond laser assisted PE show promising results due to the reduction in surgical trauma. Possible promising approaches include pathogenetically based PE for angle-closure glaucoma and simultaneous performance of both procedures, with the possibility of using modern microinvasive techniques for glaucoma surgery. Optimization of postoperative anti-inflammatory therapy and the use of antimetabolites with angiogenesis inhibitors require further study. Clinical management of these patients requires a personalized approach, taking into account the level of intraocular pressure, the stage of glaucoma, the morphology of the anterior chamber angle, and individual susceptibility to inflammation and scarring.