Cataract surgery: When should i perform a glaucoma surgery?

Glaucoma is the leading cause of irreversible blindness in France and worldwide. This condition is characterised as a progressive degenerative optic neuropathy leading to a progressive and irreversible alteration of the visual field. Intraocular pressure is the main risk factor and the main therapeutic target. The surgical indications for glaucoma are disease progression despite the use of maximal medical treatment, intolerance to or contraindications for medical and laser treatments, patients non-compliant to medical treatment, or the presence of a cataract that can accelerate the progression of glaucoma. Various surgical techniques are available to optimise pressure reduction and the safety profile for affected patients. All these techniques can be combined to cataract surgery. Filtering surgery for glaucoma (non-perforating deep sclerectomy or trabeculectomy) is the gold standard procedure for glaucoma and creates a subconjunctival filtration bleb. Transtrabecular drainage devices have recently been developed to allow a more posterior aqueous humour outflow into the subconjunctival space. Finally, new surgical techniques described as minimally invasive have been developed to enhance the safety profile and improve the reproducibility of the surgical procedure. These latest techniques are performed ab-interno and improve aqueous humour outflow by passing through the trabecular meshwork. These techniques consist of either implanting a trabecular stent or performing mechanical or laser ablation of the trabecular meshwork, and result in a reduction in intraocular pressure alongside a reduction in medication.