Management of Cataracts and Glaucoma

Bristol Eye Hospital, Lower Maudlin StreetBristol BS1 2LX, UK; bluegreeniris@hotmail.com

Anne Louise Coleman, John C Morrison, eds. London: Taylor and Francis, 2005, pp 140; ￡95. ISBN 1841842710.

Overall, this is an excellent book. It is a concise, informative discussion of the major issues surrounding the management of cataracts and glaucoma. It covers current opinion on this topic, including controversies and new treatment modalities; it is both stimulating and thought provoking. Each chapter is written by one or two highly regarded glaucoma experts and thus it is has a very broad perspective on this subject. The contributors present their strategic thinking, surgical techniques, and share their "pearls of wisdom."

This is an extremely worthwhile text for the glaucoma subspecialist and general ophthalmologist. In some respects it is perhaps too advanced for the junior trainee, although it has detailed surgical instructions and photographs and would be valuable for those learning glaucoma surgery.

In the first chapter ophthalmic anaesthetists discuss the philosophy and challenges of ophthalmic anaesthesia in routine, paediatric, and sick individuals. This is a very detailed and informative presentation of the different anaesthetic modalities for cataract and glaucoma surgery. Next, cataract surgery in patients with pre-existing glaucoma is discussed. It mentions the specific hazards encountered in cataract surgery on patients with pre-existing glaucoma, with special techniques to counter them. It also covers cataract surgery in patients with previous glaucoma surgery including drainage devices. Both of these chapters were very educational and well written.

Keith Barton considers "trabeculectomy alone." In particular, he addresses situations in which trabeculectomy alone may be appropriate, and also the potential negative aspects. There is a detailed description of his surgical technique, including discussion of releasable sutures and antimetabolites. A brief discussion of intraoperative hazards and postoperative complications is included. This chapter is particularly educational for those learning trabeculectomy surgery.

Aqueous drainage implants are covered by Richard Hill and George Baerveldt. They are presented in detail, including surgical techniques, postoperative care, and the treatment of complications. This chapter is excellent, especially for those who insert drainage devices infrequently.

Next there is a detailed discussion of non-penetrating glaucoma surgery (NPGS). The techniques include deep sclerectomy, implants (collagen, hyaluronic acid, and acrylic), viscocanalostomy, and Nd-YAG goniopuncture. Again there is detailed discussion of the surgical techniques, including excellent illustrations. Complications and their management are covered well. The authors presented this technique in such glowing light that I wondered why we aren’t all performing non-penetrating glaucoma surgery? One criticism is that these procedures are presented as being "safer but not less efficient (when performed by a NPGS trained surgeon) than trabeculectomies." There are numerous studies which have demonstrated that when comparing NPGS and trabeculectomies, lower pressures were achieved with traditional surgery; however, they do support the observation that complication rates are lower with NPGS. Also trabeculectomies have a higher probability of success over time, thus trabeculectomy could be more suitable for patients with higher intraocular pressure levels or longer life expectancies. Also I think there was inadequate emphasis on the greater technical difficulties encountered with NPGS.

One site versus two site combined cataract and glaucoma surgery is discussed at length. Joseph Caprioli and Michelle Banks present a very useful algorithm for the surgical approach to patients with cataract and glaucoma, and when to proceed to cataract surgery alone, combined surgery, or trabeculectomy alone.

There are two interesting and useful chapters looking at combined cataract-aqueous drainage device surgery and combined cataract-non-penetrating glaucoma surgery. Their benefit here is that there is a discussion of issues that are not often addressed in other texts or studies.

The last chapter covers alternative techniques to be used with cataract surgery. Endoscopic cyclophotocoagulation and trabeculectomy ab externo are presented, including the techniques and complications. Endoscopic photocoagulation is a promising technique and deserves further consideration, especially in view of the popularity of transcleral cyclodiode ciliary ablation in the United Kingdom.

Overall, this book presents a concise, well written, up to date, and comprehensive review of the management of cataracts and glaucoma. This is a book I definitely recommend.