Advanced Glaucoma and Cataract: Management Options Regenbogen Michael – Ichilov Amer Radgonde – Hadassah Ron Yonina – Beilinson Reyvitch Svetlana – Barsilai.

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Presentation transcript:

Advanced Glaucoma and Cataract: Management Options Regenbogen Michael – Ichilov Amer Radgonde – Hadassah Ron Yonina – Beilinson Reyvitch Svetlana – Barsilai Chetrit Noa – Assaf Harof Blumenfeld Oren - Wolfson Kaplan Audrey

Definition Cataract: Visually significant Advanced glaucoma: Visual field loss Moderate-severe Inadequate lowering of target pressure

Cataract Glaucoma Both are age –related Increased cataract PXF antiglaucomatous medications

Prevalence of Visual Impairment in Older Americans

Goals of Treatment Improve VA Reach target IOP Free from drugs Preserve VF

Surgical options Glaucoma surgery Cataract surgery Combined surgery

Glaucoma Surgery Trabeculectomy Non-penetrating filtering surgery Goniosynechiolysis Shunt device Endoscopic cyclophotocoagulation

Glaucoma Surgery Trabeculectomy Non-penetrating filtering surgery Goniosynechiolysis Shunt device Endoscopic cyclophotocoagulation

Glaucoma Surgery Trabeculectomy Non-penetrating filtering surgery Goniosynechiolysis Shunt device Endoscopic cyclophotocoagulation

Glaucoma Surgery Trabeculectomy Non-penetrating filtering surgery Goniosynechiolysis Shunt device Endoscopic cyclophotocoagulation

Surgical options Trabeculectomy Cataract surgery Combined surgery

Stand alone Trabeculectomy Pros: Reduces IOP +++ phacotrabeculectomy or cataract extraction Caprioli J et al.Trans Am Ophthalmol Soc Cons: Cataractogeneous Higher complication rate (hypotony, significant chamber shallowing … ) AGIS investigators Arch Oph 2001

Cataract extraction alone Pros: Cataract extraction decreases IOP per se (ACG>PXF>OAG) Dimitrov et al. Clin Exp Ophthal 2001 Friedman et al. Ophthalmology 2002 Cons: 10% IOP spike By 2 yr. 30% IOP worse than preoperative status Rainer et al. J Cat Ref Surg 1999 Hayashi et al. J Cat Ref Surg 2001

Lens extraction in PAC Pre-Phaco/IOLPost-Phaco/IOL

Combined Surgery: Best Choice One procedure improves VA and reduces IOP Quality of life Cataract surgery post trabeculectomy: more bleb failure

Combined surgery : techniques ECCE / phaco ? One site vs. two sites Limbal or fornix based With/without MMC Phacotrabeculotomy 2 sites + MMC (Vass Curr Op. 2004)

Complications Infections Hypotony Cataract formation Transient IOP elevation CME Choroidal effusion Suprachoroidal hemorrhage Leakage/failure of bleb Blebitis Endophthalmitis

Cataract+ well controlled OAG Only cataract

Cataract + CACG CATARACT SURGERY ONLY

Cataract with uncontrolled OAG moderate damage Phacotrabeculectomy +/- MMC

Cataract + advanced glaucoma (low target IOP) Phacotrabeculectomy+MMC trabeculectomy+MMC

Thank You