Internal Goniotomy
Internal goniotomy is part of a group of procedures known as minimally invasive glaucoma surgery. It is particularly well suited to patients with mild to moderate glaucoma who are undergoing cataract surgery.
A complex cataract refers to a lens opacity that develops in an eye with additional complications or pre-existing disease.
Unlike a conventional (age-related) cataract, which forms in an otherwise healthy eye, a complex cataract is associated with structural weakness, previous surgery, inflammation, trauma, or systemic conditions that make both the cataract and its surgical management more challenging.
These cases require advanced diagnostic planning and specialist expertise to restore vision safely. Complex cataracts often progress faster and may cause more profound visual symptoms than typical age-related cataracts.
Symptoms mirror those of standard cataracts but may develop more rapidly or severely, often accompanied by other visual disturbances:
Significant blurred or distorted vision
Increased glare and haloes around lights
Reduced contrast sensitivity
Double vision in one eye
Poor depth perception or imbalance between eyes
Delayed recovery or persistent visual fluctuation after prior surgery
Because complex cataracts can coincide with other ocular conditions, symptoms may vary depending on the underlying cause.
Complex cataracts may arise from a variety of causes, including:
Previous eye surgery – such as vitrectomy, corneal transplant, or refractive lens procedures.
Eye trauma – direct injury can disturb lens fibres or capsule integrity.
Zonular weakness or pseudoexfoliation syndrome – weakening of the natural lens support system.
Chronic inflammation (uveitis) – repeated episodes damage lens clarity.
High myopia or retinal disease – structural eye changes predispose to lens clouding.
Metabolic or congenital conditions – such as diabetes, galactosaemia, or inherited dystrophies.
In these situations, the cataract may be denser, less stable, or positioned atypically, requiring modified surgical planning.
Diagnosis involves comprehensive imaging and clinical evaluation to assess both the cataract and the surrounding ocular structures.
This includes:
Detailed slit-lamp examination to assess lens density and capsule integrity.
OCT scanning to evaluate the retina and macula before surgery.
Endothelial cell counts to assess corneal health.
Biometry and topography for precise intraocular lens planning.
Zonular stability testing to identify potential capsule weakness.
This holistic evaluation ensures safe surgical planning and realistic visual expectations.
You should arrange an ophthalmic consultation if:
You have blurred or misty vision that interferes with work or driving.
You’ve had previous eye surgery and now notice reduced clarity.
Your cataract appears to be progressing faster than expected.
You have co-existing eye disease (e.g. glaucoma, uveitis, corneal dystrophy).
You experience difficulty adapting to new glasses or persistent glare.
Early referral to a consultant experienced in complex cataract management prevents avoidable complications and supports safer surgery.
Internal goniotomy is part of a group of procedures known as minimally invasive glaucoma surgery. It is particularly well suited to patients with mild to moderate glaucoma who are undergoing cataract surgery.
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