Management of patients with glaucoma and cataract

The recent rise in the number of patients with both glaucoma and cataracts has increased the controversy over the management of these concurrent problems. Visual acuity, strength of medication, and previous surgery must be considered when determining whether to do cataract extraction alone, glaucoma surgery alone, or a combined procedure. We have found that the type of glaucoma the patient has influences our choice of surgery. The combined procedure is reserved for patients who have had repeated attacks of angle-closure glaucoma and those whose open-angle glaucoma is difficult to control. Thermal sclerostomy with cataract extraction was successful in maintaining intraocular pressures of 18 mm Hg or lower without medication in 48 of 58 patients.