Comorbidity of glaucoma poses some increased risks for cataract surgery, but even when there are intraoperative complications during the lens removal procedure, it is almost always possible to still add micro-invasive glaucoma surgery (MIGS), said Reay H. Brown, MD.
“We have never been better at complex cataracts, and it is rare not to do the MIGS,” said Dr. Brown, private practice, Atlanta. “Once the cataract portion is completed, it really doesn’t matter how complicated it was, as long as you were able to deal with the problem. Then, it is just you and the angle. MIGS adds very little time or risk to the case.”
Dr. Brown said that cataract surgery itself is good for glaucoma, but it also presents an opportunity to use a glaucoma implant or to perform goniotomy. In fact, it is his general practice to plan MIGS for any patient who is having cataract surgery and under treatment for glaucoma with even one medication.
“My primary goal, however, is to have safe and successful cataract surgery, and I will modify the plan and abandon the glaucoma step if the MIGS procedure is a threat,” he said.
Listing reasons not to do MIGS, Dr. Brown mentioned presence of poor visibility, which may be due to bleeding or corneal edema; if there is a narrow angle; or when the surgeon is fatigued.
“Sometimes you are just worn out, and that is not a good time to push it,” he said.