Manual Management of Cataracts and Glaucoma

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Overall, this is an excellent book. It is a concise, informative discussion of the major issues surrounding the management of cataracts and glaucoma. It covers.
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This patient has recently developed IOPs in the mid 20s and is being treated medically. Glaucoma, common in these patients, can cause marked axial length changes, which would make primary IOL power selection difficult. Despite early identification and surgical treatment, 5 patients patients and 7 developed nystagmus.

However, the means by which this number was formulated are not stated. In our series, only 3 patients had a mental status that was amenable to obtaining the Snellen letter visual acuity. It seems that even with early surgery and early optical replacement of the crystalline lens, the visual acuity is not likely to be normal in these patients, and nystagmus usually develops.


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The nystagmus was not noted at birth in these patients. It was recorded as a sensory nystagmus from poor visual development. After repeated review of the medical records, no predictive factor for poor visual development or acuity could be recognized.

When You Have Cataracts and Glaucoma | Glaucoma Research Foundation

No patients had significant optic cupping, although visualization of the optic disc was often limited because of the poor pupil dilation typically exhibited by patients with oculocerebrorenal syndrome. The mean IOP of these eyes at last follow-up was Only one of our patients patient 7 has not required medical or surgical treatment of the IOP. Both eyes of patient 5 underwent cyclocryotherapy to assist with pressure management.

Because of the few patients and the variable ages at which glaucoma was diagnosed in our series, we were unable to assess a safe age or elapsed time after which glaucoma risk would be minimized. As is generally true in pediatric glaucoma treatment, those patients who were diagnosed as having the disease within the first few weeks of life required surgery, while those diagnosed as having the disease later were better able to be treated medically.

In conclusion, early identification and surgical removal of cataracts in patients with oculocerebrorenal syndrome is recommended.

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Intraocular lens implantation at CE can be performed safely, but the lack of eye growth predictability in these infants with glaucoma makes power selection difficult. Patients with or without IOL placement should be monitored closely for changes in IOP, optic nerve cupping, and refractive error, so that glaucoma can be detected and treated promptly. Corresponding author and reprints: Submitted for publication August 13, ; final revision received February 21, ; accepted March 11, Kruger, MD ; M.

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Our website uses cookies to enhance your experience. This two-stage approach is sometimes preferred, as it has been shown that patients who underwent the two-stage procedure, had a greater percentage of long-term IOP reduction compared to those patients who underwent a combined procedure. The third approach for surgical care is for those patients in whom you would consider a combined procedure.

In those patients, the selection and glaucoma staging is very important. Although a great amount of thought may be needed to determine the correct situation for performing a combined surgery the following situations are some in which a combined approach might be considered: When performing a single surgery the patient will only be exposed to one surgical session and as such there is less risk of IOP spikes just after surgery.

This is a powerful factor when dealing with patients with advanced glaucoma and concern of loss of central vision. Cataract extraction by phacoemulsification and trabeculectomy has been shown to be a safe and effective treatment for patients with coexisting glaucoma and cataract.

Cataract Surgery and Glaucoma

Recent studies have shown that postoperative complication rates and IOP were lower when cataract surgery was combined with trabeculectomy at a two-year follow up. A single-site surgery is likely faster to perform than a two-site procedure, but more recent studies have begun to show that not only does a two-site procedure produce better post-operative IOP control, but also produce less need for adjunct glaucoma medications [18].

Wyes et al showed in that patients who underwent a two-site procedure had a mean IOP of Regardless of the type of combined procedure performed, recent studies support the claim that a combined procedure can be as effective, if not more effective, than two separate surgeries. As with all patient care issues, a sound surgical plan coupled with patient dialogue will help to set appropriate expectations for the surgery and for the post-operative management.

This approach combined with assigning glaucoma patients into one of the three above mentioned approaches would help physicians break down a complicated patient presentation into a manageable and successful treatment plan. The Academy uses cookies to analyze performance and provide relevant personalized content to users of our website.

Cataract Surgery Alone—an Underused Solution?

Create account Log in. Page Discussion View form View source History. Cataract surgery alone on an eye with glaucoma will sometimes lower the pressure in the eye. For patients with more serious glaucoma and the need for cataract surgery, a combination cataract removal and glaucoma filtering procedure can be considered.

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For patients using multiple anti-glaucoma medications, a combination procedure such as this would be appropriate. Combination procedures, however, are not for everyone. The decision to perform a combination procedure depends on the number of anti-glaucoma medications used, how mature the cataract is, and the state of the glaucoma.

As with any surgery, it is important to discuss the risks and benefits of cataract and combination surgery with your ophthalmologist to determine what is best for you. Article by Andrew G. The goal of all glaucoma surgery is to lower eye pressure to prevent or reduce damage to the optic nerve. Where the Money Goes. Like Us on Facebook. We appreciate support from corporations who believe in our mission to educate glaucoma patients and speed a cure. Contrast Dark on Light Light on Dark.


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