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Tips to addressing cataract surgery challenges in glaucomatous eyes

Use of various temporary and permanent devices for successful outcomes highlighted

Patients needing glaucoma surgery may also be candidates for a combined procedure with cataract removal and IOL implantation. For a variety of reasons, however, cataract surgery may be challenging in eyes with glaucoma.

Alan S. Crandall, MD, provided a sampling of cases to demonstrate the complexities encountered when performing cataract surgery in glaucoma patients and strategies for achieving successful outcomes.

Further reading: Innovation in glaucoma thriving 

“Considering the number of combination cases we perform, I have always felt that glaucoma surgeons should also be the best cataract surgeons,” said Dr. Crandall, professor and senior vice chairman of ophthalmology and visual sciences, and director of glaucoma and cataract at the John A. Moran Eye Center, University of Utah, Salt Lake City.

Videos from cases with pseudoexfoliation and traumatic glaucoma highlighted the potential for encountering eyes with weak, loose, and missing zonules. In eyes with traumatic glaucoma, Dr. Crandall cautioned that the extent of the zonular dialysis is probably much greater than what is initially perceived.

“In eyes with trauma, the area of zonular dialysis is probably doubled or tripled,” Dr. Crandall said. “If you see 100 degrees of dialysis, you can expect at least 2 clock hours of additional involvement on the other side.”


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