Management of coincident cataract and glaucoma

The management of patients with coincident cataract and glaucoma is a common and challenging clinical problem. Recent technologic advances in both cataract and glaucoma surgery have made the combined procedure a more viable option than in the past. The use of small-incision cataract surgery and trabeculectomy with antimetabolites performed beneath a 4-mm scleral flap with a limbus-based conjunctival flap and releasable or laserable sutures have resulted in a combined procedure that can closely mimic the standard trabeculectomy in terms of surgical methods. This discussion reviews many of the pertinent articles that have appeared in the literature during the scanning period and that address the management of combined cataract and glaucoma. The intention is not to provide a comprehensive review of this important topic but to discuss present opinions on issues such as antimetabolites, small-pupil phacoemulsification, sutured lenses, and the pseudoexfoliation syndrome as they relate to the combined glaucoma procedure.