Is it dangerous to have cataract surgery for patients with glaucoma? This is a question that patients often ask me in my outpatient work. Many patients and friends tell me that his or her acquaintances who had cataract surgery had worse vision and their glaucoma was much aggravated by cataract surgery instead. Here I would like to introduce a few typical cases to you, hoping to give you some inspiration. Case 1: Two glaucoma patients who had cataract surgery locally came to the clinic on July 12, 2011. The patients were both elderly, in good general condition, and had primary open-angle glaucoma. After cataract surgery locally, their visual acuity decreased from 0.3 and 0.1 before surgery to 0.1 and index, respectively. Both affected patients were in a poor mood. By reviewing the local ophthalmology cases, it was found that both patients’ preoperative cataracts were not very serious and their IOPs were 27mmHg and 29mmHg, respectively, and 26mmHg and 27mmHg postoperatively. fundus examination showed that both patients were advanced glaucoma patients with poorly controlled IOPs. Case 2: On July 13, 2011, a patient with closed-angle glaucoma underwent cataract surgery in our outpatient clinic. The fundus examination showed that the patient was a patient with mid-stage glaucoma. Case 3: On July 13, 2011, a patient with suspected closed-angle glaucoma underwent cataract surgery in our outpatient clinic. The fundus examination did not reveal any clear glaucomatous changes. The above three cases are typical of the cases I treated this week. Let’s analyze case 1 first: The patient in case 1 apparently had further vision loss after cataract surgery, and the IOP was not effectively controlled. The reason for this is that the main cause of vision loss is not cataract but optic nerve atrophy due to glaucoma. Patients in this situation usually have a mild cataract. In other words the degree of cataract cannot explain such poor vision. Therefore, it is conceivable that cataract surgery cannot achieve the effect of restoring vision. What’s more, the optic nerves of these patients are in a relatively atrophied stage and are very fragile to tolerate surgical blows. Therefore, even if cataract surgery is successful, it is still easy to aggravate glaucoma because of the blow to the optic nerve. In other words, cataract surgery is not an appropriate treatment option. This type of situation is mostly seen in patients with advanced open-angle glaucoma. Let’s analyze Case 2: The surgery in Case 2 was successful, with improved visual acuity and effective IOP control. The reasons are as follows: firstly, the damage to the optic nerve of the patient was not very serious and the patient had relatively good tolerance for cataract surgery; secondly, cataract surgery can reopen the atrial angle in patients with closed-angle glaucoma and effectively lower the intraocular pressure. This is because cataracts in patients with closed-angle glaucoma act like a parietal stone, pushing against the atrial angle and causing it to close. After cataract surgery, the apex is removed, and the atrial angle is usually reopened naturally, allowing the atrial fluid to drain freely and the intraocular pressure to drop. In other words, cataract surgery solves both vision and IOP problems and is the appropriate treatment. A final analysis of case 3: The patient in case 3 did not seem to have any significant improvement in vision. But again, this is a successful cataract surgery that provides long-term safety for the patient. The reason for this is that these patients are usually in the early stages of closed-angle glaucoma or at risk of developing closed-angle glaucoma and the cataract is not very severe. The benefit of surgery is that the cataract is resolved at an early stage and the atrial angle is also opened. It can be said that the progression of the disease is blocked very early in the onset. We might think of this type of surgery as a preventive surgery. And for this type of patient, there are actually other options, such as laser treatment. Now we can summarize how to choose cataract surgery for different glaucoma patients. For patients with advanced open-angle glaucoma, surgery is risky regardless of the severity of the cataract. If the cataract is not very severe but the vision is poor, then try not to have cataract surgery. For patients with closed-angle glaucoma, if the cataract is obvious, then cataract surgery is necessary to treat both cataract and closed-angle glaucoma; if the cataract is not serious, then the patient can choose cataract surgery or laser surgery. The specific choice also depends on the actual situation and needs to take into account the surgeon’s experience in surgery and whether they can do a strict review. After all, cataract surgery will be more thorough and the effect of laser treatment may not last long enough. If I were this type of patient, I would choose this way: if I have physical inconvenience and review is not easy, then I would choose an experienced surgeon to operate on me early for radical treatment; if I can do timely review and have a lot of concerns about surgery, then I would choose laser treatment. I hope the above case study will help you understand the pros and cons of cataract surgery for glaucoma patients and choose the most suitable treatment plan.