The effect of phacoemulsification and combined phaco/glaucoma procedures on the intraocular pressure in open-angle glaucoma. A review of the literature.

Purpose: This review article addresses the different aspects that influence the choice and sequence of surgical treatment in patients with coexisting open-angle glaucoma and cataract. The effect of phacoemulsification on the intraocular pressure (lOP) and on a preexisting bleb is discussed and phacotrabeculectomy and trabeculectomy are compared. Moreover, the most recent surgical pressure lowering techniques in combination with phacoemulsification are reviewed: iStent, Trabectome, Hydrus, Cypass and Canaloplasty.

Methods: Medline database was used to search for relevant, recent articles.

Conclusion: A sustained IOP decrease of 1.5 mmHg can be expected after a phacoemulsification in patients with open-angle glaucoma. The higher the preoperative pressure, the greater the IOP lowering will be. A phacoemulsification on a trabeculectomized eye will often lead to reduced bleb function and an IOP rise of on average 2 mmHg after 12 months. Compared to a trabeculectomy, phaco-trabeculectomy will have a less IOP lowering effect and a higher complication rate. iStent and Trabectome combined with phacoemulsification can decrease the IOP with 3 to 5mmHg, with a low complication rate. The combination of Cypass and Hydrus with phaco-surgery may have a more significant IOP lowering effect but long term results are not yet published. Combining Canaloplasty with phacoemulsification is a more challenging surgery but if a tension suture can be placed, an IOP decrease around 10 mmHg might be expected.