Cataract surgery common for glaucoma

San Francisco-Physicians do not typically consider cataract surgery as a form of glaucoma surgery. But while cataract removal may not be the best surgical treatment for glaucoma, it is the most common.
    
There are fewer than 100,000 glaucoma surgeries performed annually in the United States, noted Kuldev Singh, MD, MPH, professor and director of the glaucoma service at Stanford University School of Medicine in Stanford, CA. But between 480,000 and 680,000 of the patients who undergo cataract surgery annually also have glaucoma. And cataract surgery reduces IOP over at least 3 years in clinical trials.
    
“The greater your baseline IOP, the greater the pressure-lowering you can expect from cataract surgery,” said Dr. Singh during the Glaucoma 360 CME Symposium on Saturday. “And the narrower your baseline angle, the greater the IOP lowering you are likely to get.”
    
Because 15% to 20% of patients with cataracts also have glaucoma, any cataract surgery represents a potential opportunity for a glaucoma intervention. And while cataract surgery has undergone a steady evolutionary development over recent decades, glaucoma surgery is in the early stages of a revolution.

New devices and techniques are improving outcomes and reducing adverse events to cataract surgery-like rates. These new devices, some approved by FDA and some still under study here, offer dramatic opportunities for concurrent cataract-glaucoma interventions.

The Hydrus device (Ivantis) is very popular in Europe for concurrent use with cataract procedures, Dr. Singh noted and has good early evidence for long-term IOP reduction via Schlemm’s canal. A pivotal trial was recently launched in the United States.

The CyPass device (Transcend Medical) drains into the suprachoroidal space using a simple ab-interno approach. The device has not yet been approved in the United States.

There are strong reasons to combine glaucoma and cataract procedures, he concluded.
• Sustained IOP-lowering
• No adverse impact on future trabeculectomy
• Fewer trab complications
• Eliminates the risk of future trab failure
• Improved vision

“If you had a drug that lowered IOP over a sustained period and offered those other advantages, you’d have a blockbuster,” Dr. Singh concluded.

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