Combined cataract and glaucoma treatment

iStent implantation can be combined with cataract surgery to treat both cataract and glaucoma during a single procedure. The iStent is a minimally invasive glaucoma surgery (MIGS) device designed to improve aqueous fluid drainage through the eye’s natural drainage pathway & reduces intraocular pressure and glaucoma medication burden. At Eye & Laser Surgeons in Sydney, Dr Shanel Sharma and Dr Daya Sharma provide combined cataract and glaucoma surgery using modern imaging and evidence-based surgical approaches.

Many patients with glaucoma also develop cataracts.

In suitable patients, cataract surgery can be combined with:

during the same operation.

Why combine cataract and glaucoma surgery?

Combined surgery usually:

  • reduce overall treatment burden
  • lowers eye pressure
  • reduce dependence on glaucoma drops
  • improve vision affected by cataract

Many patients prefer treating both conditions during one procedure rather than separate operations.

What is the iStent?

The iStent is a very small titanium implant inserted into the eye’s natural drainage pathway.

It works by bypassing resistance within the trabecular meshwork and improving aqueous fluid drainage through Schlemm’s canal.

The goal is to:

  • lower intraocular pressure
  • improve pressure stability
  • reduce glaucoma medication burden
  • reduce glaucoma progression risk

The iStent inject W uses two microstents positioned within the drainage angle to improve outflow.

Who may benefit from combined surgery?

Combined cataract and iStent surgery may be considered for patients with:

Suitability depends on:

  • glaucoma severity
  • optic nerve health
  • drainage angle anatomy
  • target eye pressure
  • cataract severity

What testing is performed before surgery?

Pre-operative assessment commonly includes:

  • optic nerve examination
  • OCT imaging
  • visual field testing
  • eye pressure measurement
  • corneal thickness assessment
  • cataract assessment
  • drainage angle evaluation

These tests help determine:

  • glaucoma severity
  • suitability for MIGS surgery
  • target intraocular pressure
  • long-term management goals

How is the iStent implanted?

Surgeons implant the iStent during cataract surgery through the same small corneal incision used to remove the cataract.

After removing the cataract and inserting the intraocular lens, the surgeon:

  • views the drainage angle using a specialised lens
  • inserts the iStent inject W microstents into Schlemm’s canal
  • improves aqueous fluid drainage to help lower eye pressure

The additional glaucoma procedure usually adds only a few minutes to surgery.

Is recovery different from cataract surgery alone?

Recovery after combined cataract and iStent surgery is often similar to recovery after cataract surgery alone.

Patients may experience:

  • temporary blurred vision
  • mild irritation
  • light sensitivity
  • mild redness

Most patients return to normal activities relatively quickly.

Recovery is often faster than after traditional glaucoma surgery such as trabeculectomy.

Can iStent surgery eliminate glaucoma drops?

Not always.

Some patients:

  • reduce the number of glaucoma drops required
  • remain stable with fewer medications
  • continue requiring glaucoma treatment long-term

The goal is safe long-term pressure control and optic nerve protection.

Is iStent surgery safer than traditional glaucoma surgery?

MIGS procedures such as iStent generally involve:

  • smaller incisions
  • reduced tissue disruption
  • faster recovery
  • lower complication rates than traditional glaucoma surgery

However, traditional glaucoma surgery may still be more appropriate when:

  • glaucoma is advanced
  • very low target pressures are required
  • previous treatment has failed

What does the evidence show?

Clinical studies demonstrated that iStent implantation may:

  • lower intraocular pressure
  • reduce glaucoma medication burden
  • improve aqueous fluid outflow

The iStent works by bypassing trabecular meshwork resistance and improving access to Schlemm’s canal drainage pathways.

Published research supports the use of iStent in selected patients with mild to moderate open-angle glaucoma undergoing cataract surgery.

Why are more patients considering combined cataract and glaucoma surgery?

Patients increasingly consider combined surgery because:

  • treatment burden may be reduced
  • cataract and glaucoma are addressed together
  • recovery is often straightforward
  • glaucoma drop dependence may decrease
  • modern MIGS procedures are minimally invasive

At Eye & Laser Surgeons in Sydney, Dr Shanel Sharma and Dr Daya Sharma provide individualised glaucoma and cataract surgery planning using evidence-based treatment approaches and modern diagnostic imaging.

Experience with iStent surgery in Australia

Dr Daya Sharma was among the earlier Australian ophthalmologists to receive training in iStent surgery during the introduction of minimally invasive glaucoma surgery (MIGS) techniques in Australia.

At Eye & Laser Surgeons, glaucoma and cataract surgery planning incorporates:

  • optic nerve assessment
  • OCT imaging
  • visual field testing
  • ocular surface assessment
  • long-term pressure management goals

Treatment recommendations are individualised according to:

  • glaucoma severity
  • target intraocular pressure
  • cataract severity
  • lifestyle considerations
  • long-term visual goals

Frequently Asked Questions

Can iStent be implanted during cataract surgery?

Yes. Surgeons commonly implant the iStent during cataract surgery to help lower eye pressure as part of a combined cataract and glaucoma procedure.

Does cataract surgery lower eye pressure by itself?

Cataract surgery alone may reduce intraocular pressure modestly in some patients. Combining surgery with iStent may provide additional pressure reduction.

Is iStent surgery painful?

Surgeons usually perform combined cataract and iStent surgery under local anaesthesia with sedation. Patients generally experience pressure sensation rather than pain.

Can iStent surgery reduce glaucoma drops?

Many patients reduce their dependence on glaucoma medications following surgery, although some still require drops long-term.

How long does recovery take?

Recovery is often similar to recovery after cataract surgery alone, although this varies between individuals.

Is iStent suitable for advanced glaucoma?

The iStent is most commonly used in mild to moderate glaucoma. Advanced glaucoma may require alternative surgical approaches.

Book a glaucoma and cataract consultation in Sydney

If you have cataracts, glaucoma or elevated eye pressure, a comprehensive assessment can help determine whether combined cataract and iStent surgery may be appropriate.

Book a Glaucoma consultation

Eye and Laser Surgeons — Bondi Junction & Miranda

Bondi Junction: (02) 9387 5300
Miranda: (02) 9531 5300
Email: reception@eyeandlaser.com.au