title: The effect of phacoemulsification and combined phaco/glaucoma procedures on the intraocular pressure in open-angle glaucoma. A review of the literature.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Ciliaaugustinus@gmail.com
authors.forename: C J
authors.initials: CJ
authors.lastname: Augustinus
authors.forename: T
authors.initials: T
authors.lastname: Zeyen
mesh_terms: D002386:Cataract / Q000150:complications*; D002387:Cataract Extraction; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D018918:Phacoemulsification / Q000379:methods*; D011184:Postoperative Period; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome