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

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Presentation on theme: "Advanced Glaucoma and Cataract: Management Options Regenbogen Michael – Ichilov Amer Radgonde – Hadassah Ron Yonina – Beilinson Reyvitch Svetlana – Barsilai."— Presentation transcript:

1 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

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

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

4 Prevalence of Visual Impairment in Older Americans

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

6

7 Surgical options Glaucoma surgery Cataract surgery Combined surgery

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

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

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

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

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15 Surgical options Trabeculectomy Cataract surgery Combined surgery

16 Stand alone Trabeculectomy Pros: Reduces IOP +++ phacotrabeculectomy or cataract extraction Caprioli J et al.Trans Am Ophthalmol Soc 1996. Cons: Cataractogeneous Higher complication rate (hypotony, significant chamber shallowing … ) AGIS investigators Arch Oph 2001

17 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

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

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

20 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)

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

23 Cataract+ well controlled OAG Only cataract

24 Cataract + CACG CATARACT SURGERY ONLY

25 Cataract with uncontrolled OAG moderate damage Phacotrabeculectomy +/- MMC

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

27 Thank You

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