Cataract and glaucoma surgery

Written by Administrator

Wednesday, 31 October 2007

When should cataract surgery be performed for glaucoma patients? If there is significant cataract, then this can be combined with glaucoma surgery if this is also required. Deciding on cataract surgery for glaucoma patients is sometimes not an easy decision. Cataract surgery may be performed alone, combined with glaucoma surgery at the same time, or at a later date after glaucoma surgery. The decision may depend on a variety of factors: ·    the degree of cataract ·    the amount of visual field damage and optic nerve damage ·    the number of glaucoma medications that you are taking ·    whether glaucoma surgery has already been performed ·    the eye pressure before surgery ·    the desired pressure after surgery ·    tolerance for specific glaucoma medications Issues with performing cataract surgery in patients with glaucoma ·    Many patients with glaucoma have small pupils, making it difficult for the cataract surgeon to remove the cataract. Pupils may be small as a result of using pilocarpine, or due to the type of glaucoma, or inflammation / following laser procedures. ·    Some glaucomas may be associated with what is known as pseudoexfoliation syndrome. This can make cataract removal technically more difficult. The intraocular lens implant that replaces the cataract can be difficult to position. Usually this is not a problem, and visual outcomes are good, however in this circumstance the risk of certain complications are increased (for example, the surgery can take longer than expected when a "vitrectomy" is also performed, and vision can take longer to recover afterwards). ·    Cataract surgery may lead to a lower eye pressure ·    If glaucoma surgery is causing more problems than the cataract, then glaucoma surgery alone may be recommended first. Cataract surgery can be performed months later if required. Possible benefits of combining cataract and glaucoma surgery at the same time ·    Lower eye pressure than cataract surgery alone ·    Immediate improvement in vision ·    Less dependence on glaucoma medications The procedure for most patients: Typically, you will arrive at the hospital on the morning of the operation, go home a few hours afterwards and return to be seen in clinic or on the ward the following day. Most patients have their surgery under local anaesthesia. Combined cataract/glaucoma surgery may take 45 minutes. Cataract surgery typically takes between 15 and 30 minutes. What should I expect after my surgery Eye drops are required for several weeks after surgery. The nursing staff will show you how to put these in safely. Sometimes weekly review by the doctor in clinic is required in the first month, to adjust or remove sutures on occasions. You should expect some discomfort in the first few days after surgery. Lifting, heavy work & running should be avoided for at least the first month after surgery. Swimming should be avoided for at least six weeks.  You may have blurred vision in the eye for two or three weeks after surgery. Important note Please inform your surgeon if your are taking flomax or xatral, as soon as possible prior to surgery. Other advice Although you may wash your hair and face, you should avoid getting water in the eye for the first month after surgery. Contact lenses generally cannot be worn after trabeculectomy. If you were advised to discontinue aspirin or clopidogrel before glaucoma surgery, then you should restart these the day after surgery - please check with your doctor the day after surgery as occasionally there might be a reason to delay restarting such medications. Complications during surgery:   Cataract / Glaucoma surgery is delicate and can be difficult.  Complications do occur, but these are unusual and very rarely sight-threatening.  If you wish to discuss these in further detail, please ask at any time. Infection:   With modern techniques, the risk of serious infection is less than 1 in 100 cases. However if, after leaving hospital, the eye becomes more painful, sticky and red or the vision gets worse contact the hospital immediately.   Poor vision:   It is important to realise that glaucoma surgery will not improve your vision.  Indeed, vision may be slightly worse for a few weeks after the operation. Visual field:   If you have advanced glaucoma, then cataract or glaucoma surgery may rarely lead to some deterioration in visual field soon after surgery.       Please remember: To ensure you have your drops & an eye outpatient appointment before leaving hospital. Please bring your glasses & eye drops with you when you attend the clinic Restrictions – you must never rub your eye. Please let us know: If you change your address, telephone number of GP. If you will not be able to come to hospital for admission or an out-patient appointment.

Last Updated ( Friday, 09 November 2007 )