Shah Yesha S, Garg Anupam K, Ramulu Pradeep Y
Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA.
Curr Opin Ophthalmol. 2025 Jan 1;36(1):46-53. doi: 10.1097/ICU.0000000000001112. Epub 2024 Nov 27.
To review the literature evaluating the effectiveness of cataract surgery alone and cataract surgery in combination with other procedures and surgeries on intraocular pressure (IOP) in patients with ocular hypertension and glaucoma.
Recent studies of large trials have shown the IOP-lowering effect of cataract surgery and the beneficial effect of minimally invasive glaucoma surgery (MIGS). More studies are being published on when to use cataract surgery alone, with MIGS, or with traditional glaucoma surgeries for both primary open angle glaucoma and primary angle closure glaucoma.
Patients with ocular hypertension and visually significant cataracts would benefit from cataract surgery alone to lower intraocular pressure. Patients with mild to moderate glaucoma would likely benefit from cataract surgery and MIGS to achieve a lower IOP. Patients with more advanced glaucoma would benefit from cataract surgery combined with a traditional incisional glaucoma surgery. Clear lens extraction can be used in patients with primary angle closure and early primary angle closure glaucoma. In patients with more advanced disease, phacoemulsification and another glaucoma surgery is likely to be required to achieve IOP control. MIGS are starting to be used in angle closure glaucoma, although more research needs to be done to define its role.
回顾评估单纯白内障手术以及白内障手术联合其他手术操作对高眼压症和青光眼患者眼压（IOP）影响的文献。
近期大型试验研究表明了白内障手术的降眼压作用以及微创青光眼手术（MIGS）的有益效果。关于原发性开角型青光眼和原发性闭角型青光眼何时单纯进行白内障手术、联合MIGS或联合传统青光眼手术的研究越来越多。
高眼压症且有明显视力损害白内障的患者单纯进行白内障手术可降低眼压。轻度至中度青光眼患者可能从白内障手术和MIGS中获益以实现更低的眼压。病情更严重的青光眼患者将从白内障手术联合传统切口青光眼手术中获益。透明晶状体摘除术可用于原发性闭角型青光眼和早期原发性闭角型青光眼患者。对于病情更严重的患者，可能需要进行超声乳化白内障吸除术和另一种青光眼手术来控制眼压。MIGS开始应用于闭角型青光眼，尽管还需要更多研究来明确其作用。
