I am 67 years old and have had glaucoma for 20 years. I am still losing ground (my cup size is over 90%) and I can barely see to read. My doctor does not recommend cataract operations for my cataract because of the possibility of a pressure spike. Is there anything that can be done to improve my situation?

If you have glaucoma and are losing visual field, then you need surgery for the glaucoma if medications and/or laser surgery do not control the problem. If a cataract is removed as the only operation in a patient with glaucoma, particularly a patient who has uncontrolled glaucoma, a pressure spike definitely can occur. However, it is routine at the present time to do a combined cataract extraction and glaucoma operation with an adjunctive anitimetabolite, such as 5-fluo-rouracil or mitomycin C. If you have a progressive cataract and decreasing vision and your glaucoma is not controlled, then you should certainly consider having this operation. R.R.

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