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Noninfectious Uveitis: A Review of Ophthalmic Management and Clinical Pearls

Luke G Qin, Michael T Pierce, Rachel C Robbins

The uvea is a vascular stratum that includes the iris, ciliary body and choroid. Uveitis is defined as inflammation of a part of the uvea or its entirety, but it is also used to describe inflammatory processes of any part of the eye, such as the vitreous or peripheral retina. The clinical taxonomy of uveitis […]

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Combined Surgery in the Treatment of Patients with Cataract and Primary Open-angle Glaucoma

Giovanni Taibbi, Gianmarco Vizzeri
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Published Online: Aug 5th 2012 European Ophthalmic Review, 2012;6(4):218-221 DOI: http://doi.org/10.17925/EOR.2012.06.04.218
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1

Abstract

Overview

Cataract and glaucoma are the two leading causes of blindness worldwide and frequently co-exist in the ageing population. No uniform recommendations can be proposed when the two conditions are associated. In the presence of a visually significant cataract and uncontrolled glaucoma, clinicians should consider performing combined cataract surgery and trabeculectomy. Numerous phacotrabeculectomy techniques have been proposed. However, in the absence of strong evidence in support of a specific technique, surgeons’ preference and experience may dictate the choice. Unless contraindicated, mitomycin-C should be considered in all combined procedures. In addition, novel and minimally invasive glaucoma surgical procedures, such as ab interno trabeculotomy, have recently emerged and gained in popularity. In general, these procedures have shown the potential to be combined with phacoemulsification to further lower intraocular pressure (IOP) with relatively few post-operative complications. However, available data suggest that these techniques seem unlikely to be able to achieve a degree of IOP reduction comparable with that of trabeculectomy. Rigorous studies are necessary to better understand the long-term efficacy and safety profile of these novel procedures, when performed alone or in combination with cataract surgery.

Keywords

Cataract, intraocular pressure, primary open angle glaucoma, phacoemulsification, surgery, trabeculectomy

2

Article

Cataract and glaucoma are the two leading causes of blindness worldwide and frequently co-exist in the ageing population. Adequate management of these two conditions may require surgical intervention. In general, cataract extraction is necessary in case of visually significant lens opacity, while surgery for glaucoma is indicated when optimum medical therapy and/or laser surgery fails to sufficiently lower intraocular pressure (IOP) or a patient does not have access to or cannot comply with medical therapy.1

As a general rule, the management of glaucoma patients should be directed towards those treatments aimed at achieving an individualised target IOP safely and efficaciously. The presence of concomitant and visually significant cataracts can challenge the decision-making process, so that clinicians need to determine how cataract extraction would best fit the management of patients with glaucoma. In particular, when a combined surgical approach for cataract and glaucoma is desired, the timing of surgery and an accurate procedure selection are important aspects to consider. Phacotrabeculectomy techniques are not standardised and the way the procedure is performed is largely dictated by the surgeon’s preference and experience.1 Furthermore, novel and minimally invasive surgical approaches to lower IOP have been recently introduced and may be combined with phacoemulsification, representing a potential alternative to phacotrabeculectomy. This review is aimed at summarising current evidence on combined surgery in the treatment of patients with cataract and primary open angle glaucoma.

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2

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3

Article Information

Disclosure

The authors have no conflicts of interest to declare.

Correspondence

Gianmarco Vizzeri, Department of Ophthalmology and Visual Sciences, The University of Texas Medical Branch, 301 University Boulevard, Galveston, Texas 77555-1106, US. E: givizzer@utmb.edu

Received

2012-08-01T00:00:00

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Pilocarpine Hydrochloride Ophthalmic Solution 1.25%: An Innovative Prescription Eye Drop for the Treatment of Presbyopia

Selina McGee, George O Waring IV

Presbyopia is a progressive, age-related condition that reduces the eye’s ability to focus on near objects, due to gradual lens thickening and decline in its elasticity and accommodative capacity, and represents the first stage of the dysfunctional lens syndrome.1–3 Presbyopia typically affects individuals aged >40 years and is highly prevalent, affecting nearly 2 billion people worldwide […]

European Ophthalmic Review, 2012;6(4):218-221 DOI: http://doi.org/10.17925/EOR.2012.06.04.218
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