Undergoing both glaucoma and cataract surgery simultaneously is often possible. This combined approach addresses two common age-related eye conditions within a single surgical event.
Understanding Glaucoma and Cataracts
Glaucoma refers to a group of eye diseases that damage the optic nerve. This damage often results from elevated intraocular pressure (IOP) and can lead to irreversible vision loss if untreated. Vision loss is typically gradual, often affecting peripheral vision first, and may go unnoticed in early stages.
Cataracts involve a clouding of the eye’s natural lens. This obstructs light from reaching the retina, causing blurry vision, faded colors, difficulty seeing at night, and halos around lights. Cataracts are a leading cause of vision impairment and typically develop slowly with age.
The Rationale for Combined Surgery
Performing both glaucoma and cataract surgeries simultaneously offers several benefits. A primary advantage is the convenience of a single surgical event and one recovery period. This approach also reduces overall surgical risks, as the patient only requires anesthesia once.
Combining these procedures can lead to improved overall vision quality, as cataract removal enhances clarity while glaucoma management addresses optic nerve health. Cataract surgery alone can sometimes reduce intraocular pressure, offering a dual benefit. For those who find it challenging to consistently use multiple glaucoma eye drops, combined surgery might decrease their reliance on these medications.
Surgical Approaches and Procedures
When performing combined surgery, cataract removal, typically through phacoemulsification, is generally completed first. This method uses ultrasonic energy to break the cloudy lens into small pieces, which are then suctioned out. An artificial intraocular lens (IOL) is then inserted to replace the natural lens, restoring clear vision.
Following cataract removal, a glaucoma procedure is performed. Minimally Invasive Glaucoma Surgeries (MIGS) are often chosen for mild to moderate open-angle glaucoma. They are less invasive and can often use the same small incision created for cataract surgery. Examples include the iStent, which creates a permanent opening in the eye’s natural drainage system, and the Hydrus Microstent, designed to expand the eye’s drainage pathway. These procedures aim to reduce eye pressure by enhancing fluid drainage without significant additional risk.
For more advanced glaucoma, traditional procedures like trabeculectomy or glaucoma drainage device implantation may be necessary. A trabeculectomy creates a new drainage pathway in the eye’s outer layer, allowing fluid to filter out. Glaucoma drainage devices, such as shunts, are tiny tubes placed to redirect fluid from inside the eye to a small plate on the eye wall, where it is absorbed. While more invasive, these procedures provide substantial pressure reduction for severe cases.
What to Expect: Preparation, Procedure, and Recovery
Preparation for combined surgery typically involves several steps to ensure the best possible outcome. Patients will undergo comprehensive eye examinations to assess both conditions and determine suitability for the combined approach. Instructions may include adjusting current medications, especially blood thinners, and using prescribed antibiotic and anti-inflammatory eye drops in the days leading up to the surgery. Patients are usually advised to avoid eating or drinking for several hours before the procedure and to clean their face and eyes thoroughly to minimize infection risk.
The combined surgery is generally performed as an outpatient procedure, meaning the patient goes home the same day. It is often conducted under local anesthesia, which numbs the eye, combined with a sedative to help the patient relax. While the patient remains awake, they will not see the surgery itself, only bright lights and shadows. The entire combined procedure usually takes less than an hour, with the glaucoma portion adding only a short amount of time.
Recovery from combined surgery is typically quick, with most individuals able to resume daily activities within the first week, avoiding heavy lifting or eye rubbing. Patients must consistently use prescribed eye drops for managing inflammation, preventing infection, and controlling eye pressure. Follow-up appointments are essential to monitor healing, check eye pressure, and assess vision improvement, with full visual recovery continuing over several weeks.