Phacoemulsification in the Glaucoma Patient

It is becoming increasingly important for cataract surgeons to know how to surgically manage intraocular pressure (IOP). This chapter describes preoperative, intraoperative, and postoperative considerations for ophthalmologists who care for patients suffering from both cataract and glaucoma. First, the effects of standalone cataract extraction on IOP are explored. Current strategies for controlling pressure spikes are discussed. Next, an overview of how to best approach microinvasive angle procedures combined with cataract extraction is provided. Surgical instructions and pearls are offered for a subconjunctival stent, trabecular meshwork removal techniques, and trabecular meshwork stents. After that, the costs and benefits of combined phacoemulsification-tube shunts and phacoemulsification-trabeculectomies are explained. Included in the discussion is commentary on maintaining a functioning bleb before and after cataract surgery. Detailed steps for performing a phaco-tube shunt are then offered. Finally, key postoperative findings and common shared complications are identified along with tips on minimizing risks.