Surgical Options for Patients With Cataracts and Open-Angle Glaucoma

Recent studies evaluated the efficacy of MIGS combined with phacoemulsification.

Maxwell de la Paz, BS, and Linda M. Tsai, MD

Cataract and Refractive Surgery Today

Key Takeaways Recent studies have evaluated the efficacy of MIGS combined with phacoemulsification in eyes with open-angle glaucoma. Trabecular procedures combined with cataract surgery provided a greater IOP reduction than cataract surgery alone in patients with hypertensive open-angle glaucoma. Compared to phacoemulsification alone, combining the procedure with MIGS appeared to provide a greater reduction in IOP and the number of medications required postoperatively without decreasing safety. Trabecular Procedures Combined with Cataract Surgery for Open- Angle Glaucoma: A Report by the American Academy of Ophthalmology Richter GM, Takusagawa HL, Sit AJ, et al1Industry support for this study: None ABSTRACT SUMMARY This report compared the IOP reduction of various trabecular procedures combined with cataract surgery to that of cataract surgery alone in patients with hypertensive open-angle glaucoma (OAG). Patient-specific considerations that might guide procedure selection were also investigated. STUDY IN BRIEF A report drawing on 10 randomized controlled trials found that combining trabecular procedures with cataract surgery provided a greater IOP reduction than cataract surgery alone in patients with hypertensive open-angle glaucoma. The trabecular procedures themselves showed no clear benefits over one another for IOP or medication reduction, but direct comparison studies are required. The risks of uveitis and bleeding were among the factors that might influence surgeons’ choice of trabecular procedure. WHY IT MATTERS In patients with well-controlled hypertensive open-angle glaucoma, cataract surgery may reduce their medication burden by 0.8 to 1 at 2 years. When cataract surgery is combined with a trabecular procedure, a further 0.4-reduction may occur.1,2 Because the combined trabecular procedures in this AAO report offered similar benefits, patient factors and surgeon preference may be more important when offering specific options.

The First Win Is On The Surface

Cathleen M. McCabe, MD

Cataract and Refractive Surgery Today

Key Takeaways Ocular surface disease management belongs at the start of cataract and refractive surgical planning because tear film instability makes preoperative measurements unreliable, reduces refractive accuracy, degrades postoperative visual quality, and compromises patient satisfaction. Stable ocular surface data support a sound surgical plan from the outset. Patients with ocular surface disease often lack classic dry eye symptoms and instead attribute blur, glare, fluctuating vision, irritation, or reduced visual quality to cataract, a cloudy capsule, or an imperfect surgical result. Early tangible improvement builds trust in the diagnosis and strengthens treatment adherence. Long-term, multifaceted ocular surface disease management gains traction when patients experience an early win in comfort or visual quality, a milestone that supports reliable measurements before surgery and reassures dissatisfied patients after surgery. Newer therapies and treatment strategies make these early wins more achievable. Guidance on ocular surface disease (OSD) management is plentiful. Cataract and refractive surgeons understand how tear film instability can affect preoperative measurements, the refractive accuracy of surgical intervention, patients’ postoperative quality of vision, and, ultimately, their satisfaction. We also know how common OSD is in our patient population. For many of us, however, the ocular surface remains a secondary consideration—something to address after measurements are taken, the IOL is chosen, or a patient returns dissatisfied.

Incontinentia Pigmenti-Associated Retinopathy

Early screening of these patients is imperative for accurate risk assessment and timely intervention.

Sengul Ozdek, MD, FEBO; and Ece Özdemir Zeydanlı, MD, FEBO, FICO

Retina Today

KEY TAKEAWAYS Retinopathy associated with incontinentia pigmenti (IP), a rare X-linked genetic condition, carries a high risk for permanent morbidity. The course of IP-associated retinopathy varies widely: Some infants demonstrate peripheral avascular findings that remains stable for years, while others develop rapid neovascularization and tractional retinal detachment within months. Widefield fluorescein angiography is central to identifying high risk patients, particularly those with vascular activity, who require closer surveillance and often earlier intervention. Incontinentia pigmenti (IP), or Bloch-Sulzberger syndrome, is a rare X-linked dominant neuroectodermal dysplasia that presents a unique clinical challenge for vitreoretinal surgeons.1,2 Caused primarily by mutations in the IKBKG (formerly NEMO) gene, IP is typically lethal in males, leading to a more than 96% female cohort.1 While a cutaneous “marble cake” hyperpigmentation is the clinical hallmark, ocular manifestations—specifically, IP-related retinopathy—carry the highest risk for permanent morbidity. As our understanding of the vascular pathogenesis of IP evolves, management is shifting from reactive observation toward a more proactive, risk-adapted strategy. Using insights from a recent multicenter study involving more than 400 eyes, together with emerging literature, we describe how to identify high-risk patients and determine when intervention is most critical. REMARKABLE HETEROGENEITY  IP-related retinal disease is marked by striking heterogeneity in both presentation and disease course. Some infants demonstrate peripheral avascular retinal findings that remains stable for years, while others develop rapid neovascularization and tractional retinal detachment (TRD) within months (Figure).3-5 At the extreme end of the spectrum, neonates may present with advanced fibrovascular proliferation or total TRD at birth, suggesting aggressive disease can begin in utero.3,4 The biological basis for this variability remains unclear; although all patients share disruption of the NF-κB signaling pathway, genotype-phenotype correlations have not yet been established. It is possible that additional modifying genetic factors contribute to disease severity, but this hypothesis remains speculative and, as yet, lacks definitive evidence. Figure.