Relationship between cataract extraction and IOP

"We believe that timely cataract extraction could prevent complications of expected exfoliation syndrome (XFS)," asserted Professor Petja Vassileva when discussing the work she and her colleague, Dr M. Sredkova, performed on the influence of cataract extraction on intraocular pressure (IOP) in patients with XFS and exfoliation glaucoma (XFG), recently presented at the 2011 ESCRS Congress.

Debated topic

There has been much debate on the issue of management of coexisting glaucoma and cataract over the years with an emphasis on primary angle-closure and primary open-angle glaucoma (POAG). "There is a lot of data in the literature, starting in the middle of the 90s with the influence of cataract extraction, especially phaco, on the intraocular pressure (IOP)," Prof. Vassileva added.¹

Important clinical implications

"XFS is an age-related systemic disorder and all of the manifestations are severe and have important clinical implications," she said. This cause of glaucoma is common and easily identifiable. "We all know that XFS is typical above the age of 50 and its prevalence increases with age. It's usually associated with a combination of glaucoma with increased pressure and an increased prevalence of cataract," she said. "Many patients with XFS have elevated IOP leading to a development of glaucoma and 50% of eyes undergo cataract surgery after trabeculectomy."

Prof. Vassileva explained that several important but simple questions should be posed in relation to the management of coexisting glaucoma and cataract, for example, should cataract surgery alone be performed? Should cataract surgery be performed first followed by glaucoma surgery, if required? Or, glaucoma surgery first and then definitely follow with cataract surgery?