Surgery for Cataract Patients with Glaucoma– Dr. Lewis
Serving Northeast Philadelphia, the Main Line, King of Prussia, Conshohocken, Philadelphia, Phoenixville, Willow Grove, Abington, and surrounding areas.
Hydrus MicroStent, iStent, iStent Inject, GATT, Goniotomy, and Ab Interno Canaloplasty have revolutionized the management of cataract patients with mild to moderate glaucoma. The FDA has approved these techniques for the treatment of mild to moderate glaucoma at the time of cataract extraction.
We now perform Hydrus exclusively in appropriate cases of cataract with mild to moderate glaucoma. Our clinical results, in more than 200 procedures, are superior to those achieved with the other modalities. Our statistics match the three year peer-reviewed literature (Horizon Study) in which 80% of single drop glaucoma patients could safely stop their pressure lowering drops following Cat/Hydrus. More importantly, this landmark study showed a significant reduction in significant glaucoma progression (versus non-MIGS patients) thereby reducing the need for secondary invasive glaucoma surgery following three years of clinical observation.
First in the Pennsylvania, New Jersey, Delaware & Maryland to Perform The Hydrus Procedure
Dr. Lewis is the first in the area to perform this glaucoma surgery.
The procedure required to implant the Hydrus® Microstent is designed to be quick, less invasive, and performed in conjunction with cataract surgery. Doctors can now, using the unique delivery system, implant a Hydrus Microstent through the very small incisions needed for cataract surgery. No additional incisions are necessary (unlike many of the more traditional surgical procedures used to treat glaucoma). This significantly less invasive approach is called “ab-interno”, and may lead to fewer complications and faster healing times than traditional glaucoma surgery. Following cataract surgery, the Hydrus Microstent is inserted into the outflow canal of your eye, called “Schlemm’s canal.” Normally, you will not be able to see or feel the tiny device in place following your procedure.
Hydrus Implantation Animation
- Creates a permanent opening in your trabecular meshwork
- Improves your eye’s natural fluid outflow to safely lower IOP
- Works continuously to improve the outflow of fluid from your eyes
- Improves outflow with a single bypass
iStent Patient Presentation
iStent Mechanism Demonstrated (no sound)
Some Philadelphia / Bucks County cataract patients are content to continue using their glaucoma medications following cataract surgery. Unfortunately, the cost of drops and co-payments continue to rise. Furthermore glaucoma medications have systemic side effects and after years patients can develop tachyphylaxis (lower effectivity over time) and allergy to these medications. Also, immediate post-operative pressure spikes in cataract patients with glaucoma can have significant unwanted consequences. These factor motivate skilled cataract surgeons to combine cataract surgery with minimally invasive glaucoma surgery (MIGS). Similarly, many cataract and glaucoma patients prefer their surgeon address both conditions at the time of surgery. In certain cases a combined surgical procedure is absolutely necessary to maintain ocular health.
Canaloplasty combined with cataract surgery is another excellent choice for patients with cataracts and glaucoma. Alternative procedures like trabeculectomy, Xen, mitomycin trabeculectomy, Express Shunt, Ahmed Value, Molteno Tube and other setons significantly delay visual rehabilitation after cataract surgery. Dr. James Lewis has been performing combined cataract and canaloplasty to maintain excellent glaucoma pressure control after cataract surgery. Visual recovering is almost immediate and comfort is maintained. Unlike full thickness glaucoma procedures, no excessive pressure fluctuations, flat chambers, choroidals, choroidals hemorrhages, macular edema or retinal hypotony occur. Cataract extraction and canaloplasty surgery as a combined procedure take less than 30 minutes, is performed under local anesthesia, use no sutures, has no foreign body sensation and does not involve cosmetic abnormalities resulting from removal of iris tissue. (Almost all non-MIGS glaucoma procedures involve removing small portions of the iris and can distort the size and shape of the pupil.).
For patients with even more aggressive glaucoma, Dr. Lewis may choose to combine cataract surgery with an Ahmed Valve. Dr. Lewis began performing glaucoma tubes and valves under the auspices of Doug Coster (Australia) and Tony Molteno (New Zealand) in 1987.
- Glaucoma Introduction
- Glaucoma Description
- How Fluid Circulates in the Eye
- Glaucoma Cause
- Glaucoma Risk
- Ocular Hypertension
- Open-Angle Glaucoma
- Narrow- Angle Glaucoma
Nearly one out of six patients of cataract age have some form of glaucoma. Sometimes this has not been diagnosed because glaucoma is a silent condition.
The region marked A is the cataract. Excess pressure causing glaucoma is produced at B. Their proximity help explain why cataracts and glaucoma frequently co-exist. Schlemm’s canal is the exit route for excess aqueous humor C and is the focus of the Aquaflow procedure.
In addition to helping cataracts patients with glaucoma, Dr. Lewis is also experienced in treating cataract patients suffering from astigmatism and dry eye. Dr. Lewis is one of the more experienced cataracts surgeons in the United States, and he has been recognized as a foremost cataract and MIGS provider.