Cataract Surgery After Glaucoma Treatments – James S. Lewis, MD

Serving Bucks County, Philadelphia, Phoenixville, Montgomery County, Conshohocken, Delaware Valley, King of Prussia and Warminster

Surgical Options Non-penetrating deep sclerectomy (NPDS) combined with cataract surgery is an ideal choice for patients with cataracts and glaucoma.

Sometimes advanced glaucoma requiring surgery can develop before patients need cataract surgery. Procedures like mitomycin trabeculectomies, tube-shunts, and valves permanently change the fluidics of the eye. When these patients eventually develop cataracts the procedure is significantly more difficult than standard cataract extraction.

These surgeries require experience in order to obtain an excellent result. Care must be taken to avoid damaging the bleb, damaging the shunt or disrupting the valve. Since the eye has already sustained surgical trauma during glaucoma surgery, special attention must be paid to the health of the corneal endothelial cells. Sometimes these cataracts Philadelphia patients require refinement of the filtering bleb. In addition, these patients may require repositioning, reinsertion, augmentation, or replacement of the shunt.

Intraocular lens implantation in glaucomatous eyes is limited to posterior chamber implants. Rupturing the posterior capsule capsule during surgery is not an option since anterior chamber intraocular lenses are contraindicated in glaucoma. If a mishap occurs, surgeons must be prepared to use special techniques to get a posterior chamber intraocular lens fixated in the eye.

In 1991, I published the landmark article on suture fixation of posterior chamber lenses. I developed the technique after seeing glaucoma patients who could not have an intraocular lens placed in the posterior chamber. These patients were forced to use aphakic contact lenses or aphakic spectacles. This was a considerable burden and provided only limited visual rehabilitation. This technique, the Lewis Suture, is still the treatment of choice for suture support of a posterior chamber intraocular lens when the posterior capsule is damaged during cataract surgery.

I have the privilege of performing cataract surgery for one of the largest glaucoma practices in the region. Dr. G. Richard Bennett, one of just a handful of glaucoma specialists who were funded by the National Eye Institute of the National Institute of Health to investigate the treatment of ocular hypertension (OHTS). Dr. Bennett, Professor and Director of the Glaucoma Service at Salus University has thousands of patients who have glaucoma surgery and who have not had their cataracts removed. I have spent the last seven years operating on these patients once their cataracts develop. This experience makes our practice one of the most experienced in cataract surgery after glaucoma surgery.