Cataract and Glaucoma Surgery

Overview

Combined cataract and glaucoma surgery treats two conditions in one operation for people who have both a cataract (a clouded natural lens) and glaucoma (optic-nerve damage usually linked to raised eye pressure). The surgeon removes the cataract and implants a clear artificial lens while also performing a procedure to lower eye pressure and reduce the need for glaucoma drops.

The glaucoma part may be a minimally invasive glaucoma surgery (MIGS) device that boosts the eye’s natural drainage, or a more powerful filtering operation such as trabeculectomy or a tube shunt that creates a new drainage pathway. Combining surgery spares the patient two separate operations and can improve both clarity and pressure control.

Glaucoma cannot be cured and existing nerve damage is permanent, so the aim is to protect remaining vision, not restore lost sight. This page is an educational overview only — it is not medical advice, and no outcome can be guaranteed.

Who May Need This

Combined surgery suits people who have a visually significant cataract and glaucoma that needs better pressure control or where reducing drop burden would help. It is often considered when someone is already facing cataract surgery and also has glaucoma that is not fully controlled, is progressing, or is difficult to manage with drops alone.

The suitability and choice of glaucoma procedure depend on the type and severity of glaucoma and the target pressure. An ophthalmologist, often a glaucoma specialist, assesses both conditions and the optic nerve to decide whether to combine surgery and which technique to use.

When It May Be Recommended

It may be recommended when a cataract is affecting vision and glaucoma also requires intervention — for example when pressure is inadequately controlled, the optic-nerve damage is progressing, or the patient struggles with or wants to reduce eye drops. Combining avoids operating twice and lets the pressure be addressed at the same time.

If only one condition needs treatment, surgery may be limited to that. For advanced glaucoma needing a large pressure reduction, a stronger filtering procedure may be combined or done separately. The recommendation is individualised after evaluating both conditions.

Diagnosis and Evaluation

Evaluation covers both conditions: grading the cataract at the slit lamp and performing biometry to calculate the lens implant, and assessing glaucoma with eye pressure measurement, optic-nerve imaging (OCT), visual field testing, and examination of the drainage angle (gonioscopy). Together these determine the target pressure and the appropriate glaucoma technique.

The surgeon reviews current glaucoma drops, general health, and medications, and discusses the lens choice, noting that some premium lenses are less suitable in advanced glaucoma. A second opinion may be valuable, particularly for advanced glaucoma or complex eyes.

Treatment Options

Options range from cataract surgery alone (which itself can modestly lower pressure and may suffice in mild glaucoma) to cataract surgery combined with a MIGS device for mild-to-moderate glaucoma, or with a filtering operation (trabeculectomy or tube shunt) for more advanced or poorly controlled glaucoma.

The glaucoma could also be managed separately with drops or laser (such as SLT) while the cataract is removed alone. Each option offers a different balance of pressure-lowering power and risk. The surgeon matches the technique to the severity of the glaucoma and the target pressure.

How It Is Performed

Surgery is usually an outpatient procedure under local anaesthesia. The cataract is removed by phacoemulsification — ultrasound breaks up the cloudy lens, which is aspirated through a tiny incision, and a folded intraocular lens is implanted into the lens capsule.

The glaucoma step is then added: a MIGS device or stent may be placed to improve natural drainage, or a trabeculectomy is created (a guarded flap that lets fluid drain into a small blister, or bleb, under the eyelid), or a tube shunt is inserted. MIGS adds only a little time and risk, whereas filtering surgery is more involved and needs closer monitoring. The eye is closed with tiny sutures as needed.

Preparation

Preparation includes biometry and glaucoma assessment, a discussion of the lens and glaucoma technique, and review of medications with your surgeon, including which glaucoma drops to continue and any blood thinners. Follow instructions on drops and fasting, and arrange for someone to take you home.

If you are travelling abroad, be aware that combined surgery — especially filtering surgery — needs more follow-up than cataract surgery alone, sometimes with adjustments to the drainage in the weeks afterwards. Plan an adequate in-country stay, bring your glaucoma records and fields, and arrange continuing care at home.

Benefits and Expected Goals

The goals are to restore clarity by removing the cataract, lower eye pressure to protect the optic nerve, and reduce the number of glaucoma drops needed — all in a single operation. Many appropriately selected patients gain clearer vision and better-controlled pressure with fewer drops.

Benefits vary with the type and severity of glaucoma and the technique used. Glaucoma damage already present will not reverse, MIGS gives a more modest pressure reduction than filtering surgery, and some people still need drops. Your surgeon can set realistic goals for both conditions.

Risks and Possible Complications

Combining surgery adds the risks of the glaucoma procedure to those of cataract surgery.

• Eye pressure that is too high (inadequate control) or too low (hypotony), especially after filtering surgery
• Bleeding or inflammation inside the eye
• Infection, including of a filtering bleb (which can occur even long after surgery)
• A leaking or failing drainage bleb, or scarring that blocks drainage
• Standard cataract risks: posterior capsule opacification, macular swelling, or a lens issue
• Progression of glaucoma despite treatment, and rarely, loss of vision

Your surgeon will explain the risks specific to your eyes and technique and how each is managed. Report increasing pain, redness, discharge, or vision changes promptly.

Recovery, Follow-up & Aftercare

Recovery is usually more closely monitored than for cataract surgery alone. The cataract portion often clears vision within days to weeks, while the pressure result is assessed over weeks to months. You will use antibiotic and anti-inflammatory drops and may continue or adjust glaucoma drops as directed.

After filtering surgery, the drainage bleb may need adjustment (such as releasing sutures or gentle massage) at follow-up visits, and you should avoid heavy lifting and eye rubbing. Attend all follow-up appointments so pressure and the optic nerve can be monitored, and arrange ongoing glaucoma care with a specialist at home before returning.

Medical Tourism Planning

If you are considering combined surgery abroad, choose a JCI- or ISO-accredited hospital with a glaucoma service and a surgeon experienced in the specific glaucoma technique planned. Ask whether MIGS or filtering surgery is recommended and why, and how the pressure result will be followed.

Because glaucoma is lifelong and filtering surgery needs early adjustments, plan an adequate in-country stay and arrange continuing glaucoma monitoring with a specialist at home. Request a written treatment plan and cost estimate specifying the lens and glaucoma procedure, and consider medical travel insurance.

Estimated Cost Factors

The cost depends on the country and hospital, the surgeon’s fees, the type of lens, and the glaucoma technique — MIGS devices and stents, trabeculectomy, or tube shunts differ substantially in price and follow-up. Whether one or both eyes are treated, anaesthesia, and the more extensive follow-up all affect the total.

Many destinations offer this surgery at a fraction of typical US prices, but figures vary widely and online prices are only estimates. Always request a personalized written quote that specifies the lens, the glaucoma procedure, and follow-up before deciding.

Choosing a Hospital or Specialist

Look for an accredited hospital with a dedicated glaucoma service and a surgeon experienced in both cataract and glaucoma surgery, ideally a glaucoma specialist for the technique you need. Ask about their experience with MIGS and filtering surgery, their outcomes, and how they manage pressure complications.

Confirm the imaging and visual-field testing available, how long-term glaucoma monitoring will be coordinated, and what international patient services and follow-up are offered. Transparent written pricing and a clear plan for both conditions are signs of a quality programme.

Alternatives

Alternatives to combining surgery include treating the conditions separately — cataract surgery alone (which may modestly lower pressure) with glaucoma managed by drops or laser (SLT), or glaucoma surgery done at a different time. In mild glaucoma, cataract surgery alone is sometimes enough.

Each strategy has a different balance of benefit, risk, and follow-up. The best choice depends on how advanced each condition is and your target pressure. Discuss the options with a glaucoma specialist so the plan fits both your cataract and your glaucoma.

Questions to Ask Your Doctor

• How advanced is my glaucoma, and how much pressure lowering do I need?
• Do you recommend MIGS or a filtering operation combined with my cataract surgery, and why?
• Am I likely to still need glaucoma drops afterwards?
• Which lens implant is suitable given my glaucoma?
• What are the specific risks in my case, and how are pressure problems managed?
• How much follow-up will I need, and how will my glaucoma be monitored at home?
• What is included in the written cost estimate, including the glaucoma procedure?