title: Lens-based glaucoma surgery: using cataract surgery to reduce intraocular pressure.
abstract: Cataract surgery has been demonstrated to lower intraocular pressure (IOP) in eyes with glaucoma. The evidence is strong in angle-closure patients that cataract surgery improves IOP and dramatically reduces the future risk for IOP spikes and acute attacks. Randomized controlled trials (RCTs) have shown that cataract surgery may be preferable to laser iridotomy or phacotrabeculectomy. The data are so convincing that an RCT has been undertaken to assess whether clear lens extraction may be appropriate following acute attacks and in cases of uncontrolled IOP. The case favoring cataract surgery in open-angle glaucoma (OAG) is more controversial. Impressive IOP reduction has been shown in OAG patients when the patients are stratified by preoperative IOP. The patients with the highest preoperative IOPs have pressure reductions up to 8.5 mm Hg. However, these findings have been criticized for methodological weaknesses. Combining cataract surgery with microinvasive glaucoma surgery in phaco-plus procedures provides further options for lens-based glaucoma surgery.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the Atlanta Ophthalmology Associates (Brown), Atlanta Veterans Administration Medical Center and Emory University Eye Center (Lynch), Atlanta, Georgia, and the University of Miami Miller School of Medicine (Zhong), Miami, Florida, USA. Electronic address: reaymary@comcast.net.
authors.forename: Reay H
authors.initials: RH
authors.lastname: Brown
authors.affiliation: From the Atlanta Ophthalmology Associates (Brown), Atlanta Veterans Administration Medical Center and Emory University Eye Center (Lynch), Atlanta, Georgia, and the University of Miami Miller School of Medicine (Zhong), Miami, Florida, USA.
authors.forename: Le
authors.initials: L
authors.lastname: Zhong
authors.affiliation: From the Atlanta Ophthalmology Associates (Brown), Atlanta Veterans Administration Medical Center and Emory University Eye Center (Lynch), Atlanta, Georgia, and the University of Miami Miller School of Medicine (Zhong), Miami, Florida, USA.
authors.forename: Mary G
authors.initials: MG
authors.lastname: Lynch
mesh_terms: D002387:Cataract Extraction; D015812:Glaucoma, Angle-Closure / Q000503:physiopathology*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D007908:Lens, Crystalline / Q000601:surgery*