• Glaucoma Procedures Combined with Cataract Surgery

    Reviewed By J Kevin McKinney MD
    Sep. 16, 2020

    Cataract surgery and trabeculectomy

    For those with more severe glaucoma, having a trabeculectomy with cataract surgery may lead to lower eye pressure. Your ophthalmologist removes your eye’s cloudy lens and replaces it with an artificial one. During the trabeculectomy, your surgeon creates a tiny opening, or flap, in the white of your eye. Then a bubble-like pocket, called a bleb, is also created over the white of the eye. The excess fluid drains out of the eye through the flap and into the bleb. The fluid in the bleb is absorbed naturally by the body, lowering eye pressure.

    Illustration of a trabeculectomy, when a surgeon creates a tiny flap in the white of your eye to lower intraocular pressure from glaucoma

    Cataract surgery and glaucoma shunt procedures

    During this surgery, your ophthalmologist will remove your eye’s cloudy lens and replace it with an artificial one. To help lower your eye pressure, he or she will also put a tiny, plastic tube called a shunt under the thin, clear membrane covering the white of your eye. The shunt sends blocked fluid inside the eye to a small, plastic plate your surgeon puts on the eye wall. There, the fluid is absorbed by blood vessels nearby. This helps lower eye pressure.

    Image of aqueous fluid exiting eye onto the implant plate on white of eye

    Cataract surgery and newer glaucoma surgeries

    There are some newer glaucoma procedures that do not require as much cutting into the eye. These procedures are called MIGS, or microinvasive glaucoma surgeries. Many of these surgeries can be combined with cataract surgery for people with mild to moderate open-angle glaucoma. These procedures use the same incision, or small cut, to enter the eye that your surgeon uses to remove the cataract. Most MIGS surgeries move the trapped fluid from the eye by removing the blockage or bypassing it with a small tube or stent. These surgeries help lower eye pressure but may not lower it enough to stop all glaucoma medications.

    Combined cataract and glaucoma surgery is not for everyone

    • Sometimes a cataract is not causing vision problems, but the glaucoma needs to be treated. In these cases, it is best to do the glaucoma surgery and delay cataract surgery until later.
    • In other cases, glaucoma is well-controlled without surgery but cataracts are limiting vision. In these cases, cataract surgery alone or cataract surgery with MIGS may be the best option.
    • Other patients have cataracts and a kind of glaucoma called narrow- or closed-angle glaucoma. With this type of glaucoma, the iris (colored part of your eye) is pushed too far forward, blocking fluid from leaving the eye. This raises eye pressure. A cataract can make this type of glaucoma worse. With the cataract removed, eye pressure may improve without glaucoma surgery.