This review analyzes the most relevant studies on current surgical strategies to treat glaucoma patients with cataracts. No clear evidence has confirmed better results with trabeculectomy alone compared with phacotrabeculectomy. Recent studies have reported successful outcomes combining deep sclerectomy and two-site phacoemulsification. The phacoemulsification cataract extraction will not vary the intraocular pressure of patients with previous deep sclerectomy. Mitomycin C proved to be effective in maintaining lower pressure levels with the combined surgery technique; however, 5-fluorouracil did not show any improvement. Minimally invasive cataract surgery reduces surgical trauma, making it possible to obtain better results with combined surgery and previous glaucoma surgery. The surgical strategy decision must be customized to every patient. Only filtering surgeries are recommended in glaucoma patients with incipient cataract. Combined surgical procedures are recommended for progressive or advanced glaucoma. Two-site phacotrabeculectomy with mitomycin C achieves better stabilized results; however, combined phacoemulsification with deep sclerectomy or viscocanalostomy achieves similar results with a lower rate of complications. These promising findings need more study to be confirmed.

Purpose: To study the clinical effectiveness of deep sclerectomy using the erbium:YAG (Er:YAG) laser in patients with open-angle glaucoma (OAG). Setting: Department of Ophthalmology, Institut Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain. Methods: This nonrandomized prospective clinical study was performed in 46 consecutive eyes with OAG. Seventeen patients had not received any treatment for glaucoma. Eight had received 1 medication; 14, 2 medications; and 7, 3 medications. The mean duration of treatment was 18.3 months ± 9.4 (SD). After mitomycin-C 0.02% was administered for 2 minutes, a superficial 4.0 mm × 4.0 mm scleral flap was created and a deep 3.0 mm × 3.0 mm scleral ablation was performed with the Er:YAG laser. Schlemm's canal was removed, and the cornea was dissected to Descemet's membrane until aqueous humor percolated. The scleral flap and conjunctiva were closed. Postoperative follow-up examinations were done at 1, 3, and 7 days, 2, 3, and 4 weeks, and then every 3 months up to 15 months. Results: The mean preoperative intraocular pressure (IOP) was 28.3 ± 6.1 mm Hg. The mean postoperative IOP was 14.1 ± 3.5 mm Hg at 24 hours, 16.3 ± 4.2 mm Hg at 3 months, and 15.3 ± 2.7 mm Hg at 15 months (P < .001). There were no statistically significant differences in IOP by sex or age. There was a statistically significant difference between patients receiving no medication and those who received more than 2 medications and a treatment period longer than 1 year preoperatively (P < .006). The presence of a filtering bleb was associated with a longer period of decreased IOP (P < .007). The success rate (IOP ≤18 mm Hg without medication) was 93.47% at 1 month and 84.78% at 15 months. The number of complications was significantly lower than in previous reports of trabeculectomy. One patient lost 2 lines of visual acuity because of cystoid macular edema. Conclusions: Deep sclerectomy using the Er:YAG laser was safe and effective in eyes with OAG. More studies are needed to analyze the mechanism of lowering IOP.

To study the effectiveness of an erbium:YAG (Er:YAG) laser in removing nuclei of various densities. University clinic. This nonrandomized prospective clinical study included 147 consecutive cataractous eyes: Group 1 (n = 71) had conventional ultrasound, and Group 2 (n = 76) had surgery with the Er:YAG laser. The 2 groups were further classified by cataract density. Patients were examined 6 months postoperatively to evaluate surgical time, intraocular pressure (IOP), pachymetry, endothelial cell loss, and visual acuity. With ultrasound cataract surgery, there were no significant changes in IOP compared with the preoperative measurements. Laser treatment of 3+ and 4+ cataracts resulted in IOP increases of 12.6% and 18.2%, respectively, compared with 1+ and 2+ cataracts (P<.001). Slight endothelial cell losses occurred in all cases. With ultrasound, the mean decrease was 2.8%, and with laser surgery, the results were similar except for a significant decrease of 13.4% with 4+ cataracts. There was a correlation between pachymetry and surgical time when the trauma related to surgical time and hydrodynamic flow in the anterior chamber was assessed. With ultrasound, the visual acuity was similar with all types of cataract; with the laser, similar normal values were seen with 1+ and 2+ cataracts but decreased values were seen with 3+ cataracts and lower values with 4+ cataracts-0.43 compared to 0.84 best corrected visual acuity with same-density cataracts treated with ultrasound (P<.0005). Patients with 4+ cataracts treated with the laser developed more complications than those treated with ultrasound. The Er:YAG laser was as effective and reliable as ultrasound in removing soft and medium-density cataracts. With dense cataracts, the surgical length produced more trauma and complications during laser treatment than during ultrasound treatment.

Purpose: To validate the efficacy of RedTouch laser, a new 675 nm laser system in treating dry eye disease (DED) secondary to Meibomian gland dysfunction (MGD), comparing generalized periocular treatment versus direct targeting of the meibomian glands. Patients and Methods: 70 patients with mild and moderate DED-MGD received 4 sessions of laser treatment separated by 3 weeks, with assessments before treatment, T0, and at the end, T1, after 2 months from the last session. Patients were divided randomly into 2 groups (G1 and G2) of 35 patients each to test different protocols. In G1, the eyelids and periocular area were treated with a 675 nm laser and G2, with the same treatment as in G1 but combined with a free pencil-shaped handpiece on the tarsal conjunctiva of the superior and inferior eyelids as well as on the lid margin of both eyelids. Results: The outcomes resulted in a significant improvement in all symptoms and signs of both groups, OSDI, CFS, NITMH, NITBUT, Osmolarity and Schirmer test1. However, G2—receiving additional targeted meibomian gland treatment—showed superior outcomes across all parameters (G1 vs G2, p < 0.001), including the signs of the Meibomian glands and the lid margin (G1 vs G2, p < 0.001). Conclusion: RedTouch laser is an effective treatment in patients with DED related to MGD, improving signs and symptoms. While periocular skin treatment alone provides clinical benefits, outcomes are significantly better when the laser is applied directly to the lid margin and tarsal conjunctiva, targeting the meibomian glands more specifically. No complications were observed.