Glaucomatous Progression Following Combined Phacoemulsification and Simultaneous Goniotomy in a Patient with Primary Open-Angle Glaucoma
Abstract
INTRODUCTION: This case presentation describes rapid glaucomatous progression following phacoemulsification and simultaneous goniotomy. The objective of this project is to evaluate the speed and scope of visual field decline in a patient after undergoing these combined procedures for cataract and glaucoma management, exploring the risk factors for rapid progression of glaucoma damage during the post-operative period. METHODS: A 74-year-old male with mild primary open-angle glaucoma (POAG) and cataracts underwent uneventful phacoemulsification with simultaneous goniotomy in both eyes. Longitudinal surveillance was conducted over twelve months using Perkins tonometry, Humphrey Visual Field (HVF) 24-2 testing, and optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) and macula to monitor for disease progression. RESULTS AND CONCLUSION: Although the surgical process was uncomplicated, the post-operative period included intermittent intraocular pressure (IOP) spikes, with elevations reaching 35 mmHg in the right eye and 31 mmHg in the left eye. Subsequent assessments revealed significant structural and functional deterioration: the right eye progressed from mild to severe stage POAG with a superior altitudinal defect, and the left eye progressed to a moderate-to-severe stage with worsening arcuate defects and significant RNFL thinning. While typically, minimally invasive glaucoma surgery is not associated with significant risks of rapid visual field loss, in this case post-operative IOP spikes led to a significant decline in the visual field in a short amount of time. We conclude that patients undergoing phacoemulsification and simultaneous goniotomy require frequent surveillance, as immediate surgical success does not preclude rapid, irreversible progression of glaucoma.
Start Time
15-4-2026 1:30 PM
End Time
15-4-2026 4:30 PM
Room Number
Culp Ballroom 316
Poster Number
7
Presentation Type
Poster
Presentation Subtype
Posters - Competitive
Presentation Category
Science, Technology, and Engineering
Student Type
Graduate and Professional Degree Students, Residents, Fellows
Faculty Mentor
Brent Aebi, MD
Glaucomatous Progression Following Combined Phacoemulsification and Simultaneous Goniotomy in a Patient with Primary Open-Angle Glaucoma
Culp Ballroom 316
INTRODUCTION: This case presentation describes rapid glaucomatous progression following phacoemulsification and simultaneous goniotomy. The objective of this project is to evaluate the speed and scope of visual field decline in a patient after undergoing these combined procedures for cataract and glaucoma management, exploring the risk factors for rapid progression of glaucoma damage during the post-operative period. METHODS: A 74-year-old male with mild primary open-angle glaucoma (POAG) and cataracts underwent uneventful phacoemulsification with simultaneous goniotomy in both eyes. Longitudinal surveillance was conducted over twelve months using Perkins tonometry, Humphrey Visual Field (HVF) 24-2 testing, and optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) and macula to monitor for disease progression. RESULTS AND CONCLUSION: Although the surgical process was uncomplicated, the post-operative period included intermittent intraocular pressure (IOP) spikes, with elevations reaching 35 mmHg in the right eye and 31 mmHg in the left eye. Subsequent assessments revealed significant structural and functional deterioration: the right eye progressed from mild to severe stage POAG with a superior altitudinal defect, and the left eye progressed to a moderate-to-severe stage with worsening arcuate defects and significant RNFL thinning. While typically, minimally invasive glaucoma surgery is not associated with significant risks of rapid visual field loss, in this case post-operative IOP spikes led to a significant decline in the visual field in a short amount of time. We conclude that patients undergoing phacoemulsification and simultaneous goniotomy require frequent surveillance, as immediate surgical success does not preclude rapid, irreversible progression of glaucoma.
