Challenging Situations

*Current Cataract Surgical Techniques*

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**20**

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**23**

**Chapter 2**

**Abstract**

OMNI

**1. Introduction**

*and Jose Marí Cotino*

Cataract Surgery Combined with

Cataract surgery decreases significantly and with maintained effect intraocular pressure (IOP) in both normal eyes as in eyes with glaucoma. In patients with cataracts and glaucoma, it can be performed, isolated or in combination with other techniques, such as the following: minimally invasive glaucoma surgery (MIGS) in patients with mild/moderate glaucoma that do not require a high tensional decrease; and conventional glaucoma surgery techniques in patients with advanced glaucoma. Although lower than with conventional techniques, MIGS trabecular surgery has a good IOP lowering effect and provides some of the following advantages: a more physiological approach; little traumatic; without bleb; and it does not limit other techniques in the future. Different techniques that combinated or not with cataract surgery facilitate the exit of aqueous humor through the trabecular meshwork (TM) have been described. Our aim in this chapter is to review the newest of them, such as the following: iStent;

**Keywords:** cataract surgery, glaucoma surgery, MIGS, iStent, ELT, Kahook, ABiC,

It has been shown that after phacoemulsification in eyes with and without glaucoma, there is a decrease in IOP in relation to the preoperative one, with a decrease of up to 8.5 mmHg, 34% of the preoperative IOP, in eyes with glaucoma and IOP between 29 and 23 mmHg and 3.4 mmHg; and 18% of the IOP in eyes with preoperative IOP lower than 20 mmHg [1]. Moreover, the decrease in IOP is maintained up to 10 years follow-up without influence of the age of the patients [1]. Therefore, we can affirm that the cataract extraction, regardless of the surgical technique used, provides a reduction in preoperative IOP, maintained during follow-up, which is related to preoperative, both in normal eyes and in ocular hypertensive with or without treatment, and even in eyes with glaucoma and hypotensive medical treatment. Therefore, cataract surgery can be considered as an antiglaucomatous surgical technique, which could the indicated treatment in hyperopic eyes and adequate glaucoma control with medical treatment and in glaucomatous patients, with correct medical control, if we do not pursue a large decrease in IOP [2].

However, when a big IOP decrease is required or in the case of advanced glaucomas, we will use the classic surgical techniques for the treatment of glaucoma: trabeculectomy

Trabecular MIGS (Minimally

Invasive Glaucoma Surgery)

*Marina Aguilar González, Jorge Vila Arteaga* 

ELT (Excimer Laser Trabeculostomy); kahook; ABiC; and OMNI.
