Supplementary Material for: Phacoemulsification and Glaucoma

Cataract and glaucoma are main causes of blindness and visual impairment in Europe and worldwide. Both conditions are associated with the aging process, and their prevalence is expected to further increase with population aging. Moreover, both medical and surgical treatment of glaucoma is associated with an increased risk for cataract development. For these reasons, coexistence of cataract and glaucoma is frequently observed. Modern cataract surgery with intraocular lens implantation is an extremely cost-effective procedure with positive influences on quality of life (QoL) measures and visual functioning. Unfortunately, similar success measured in terms of QoL may not be achieved with the management of glaucoma patients with a functional disability caused by visual field loss. Advanced visual field loss may limit visual improvement after phacoemulsification (PE), and a concurrent glaucoma procedure may delay visual recovery. Recent studies show that PE plays an increasingly important role in the management of both open-angle and angle closure (AC) glaucoma. PE, however, can be technically more challenging in glaucoma patients due to ocular conditions such as the exfoliation syndrome, a previous episode of acute AC attack or a history of past ocular surgeries, miotic therapy, trauma, or uveitic glaucoma. Uncomplicated PE alone may serve to lower the long-term intraocular pressure (IOP) in some circumstances. Several surgical strategies exist: PE alone, PE followed by glaucoma surgery, glaucoma surgery followed by PE, and combined PE and glaucoma surgery at the same time. There is no consensus regarding the optimal sequence of surgery; the decision is influenced by numerous factors, including the type of glaucoma, the degree of glaucomatous loss, target IOP, lens opacity, the number of IOP-lowering drugs, patient compliance, the experience of the surgeon, and impact on QoL.