EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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EW FEATURE 50 Combined procedures for glaucoma November 2014 AT A GLANCE • The use of combined phaco- trabeculectomy is changing. • The 2013 ASCRS Clinical Survey found that 45% of respondents perform only phacoemulsification in cases of mild or moderate glaucoma. • In that survey, 10% performed iStent cataract surgery. • Combined cataract-glaucoma procedures averaged only about 10% of cataract cases, according to the survey. by Rich Daly EyeWorld Contributing Writer Jeffrey A. Kammer, MD, associate professor of ophthalmolo- gy, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tenn., said surgeons used to fear performing cataract surgery in the glaucoma population, which drove the use of the combined phacoemulsification- trabeculectomy procedure. "In this day and age, we have a lot more data to consider as we formulate a treatment plan," Dr. Kammer said. "In the appropri- ate patient population, I prefer a straight cataract surgery." The consistent drop in IOP provided by cataract surgery, as identified by several studies, demon- strated the benefits of that stand- alone procedure. Glaucoma patients require close postoperative IOP tracking and may require IOP-lower- ing meds, but they typically benefit from the surgery's decrease in IOP. In patients with mild to moderate glaucoma, Dr. Kammer frequently uses microinvasive glaucoma surgery (MIGS) IOP- lowering options, such as the iStent (Glaukos, Laguna Hills, Calif.) or ECP (endoscopic cyclophotocoagula- tion, Endo Optiks, Little Silver, N.J.), to compliment cataract surgery by providing additional IOP lowering. Trabectome (NeoMedix, Tustin, Calif.) is another option before a trab, Dr. Kammer said. professor, Jules Stein Eye Institute at the UCLA School of Medicine, and in private practice, Devgan Eye Surgery, Los Angeles, has replaced a growing share of his combined phaco-trab procedures with a staged approach that uses cataract surgery alone as the first step. "Oftentimes the cataract surgery alone is enough to allow a decrease in the IOP-lowering medications that are used postop," Dr. Devgan said. "In addition, there are now [MIGS] devices that can be inserted Dr. Kammer's reduced use of the traditional combined procedure echoes the results of the 2013 ASCRS Clinical Survey, which found that 45% of respondents perform only phacoemulsification in cases of mild or moderate glaucoma. Ten percent performed iStent cataract surgery. Meanwhile, traditional combined cataract-glaucoma procedures averaged only about 10% of cataract cases. Uday Devgan, MD, chief of ophthalmology, Olive View-UCLA Medical Center, associate clinical Refocusing phaco-trab use Monthly Pulse Keeping a Pulse on Ophthalmology Surgeons are limiting their use of the combined phacoemulsification- trabeculectomy procedure, as well as changing the way they use it S ome surgeons report reductions in their use of traditional combined cataract and glaucoma treatment procedures due to increasing treatment options and understanding of the disease. An eye undergoing cataract surgery that had a trabeculectomy performed several months earlier through a separate incision. Source: Uday Devgan, MD