[Surgical controversy. Combined cataract and glaucoma surgery]

A two-phase surgical approach may be chosen with the glaucoma intervention done first when there is advanced glaucomatous involvement and only moderate lens opacity; and cataract surgery is the first priority when there has been substantial vision loss due to the lens with a moderate case of glaucoma stabilized medically. In the case of closed-angle glaucoma, it may be preferable to operate on the lens alone rather than perform filtration or combined surgery. Our personal experience with 31 patients undergoing phacotrabeculectomy at two sites without adjunctive antimetabolites has shown that this technique is effective in controlling intraocular pressure in glaucoma patients (mean decrease in pressure, 29%), with few complications.