The management of patients with conjoint cataract and glaucoma

The frequency with which patients are beset with both cataract and glaucoma has risen and will continue to rise. The present report compares several different approaches to the management of 129 cases of conjoint cataract and glaucoma, including cataract extraction alone, trabeculectomy followed by cataract extraction, and cataract extraction performed simultaneously with either trabeculectomy, partial-punch sclerectomy, iridencleisis, or cyclodialysis. None of the single approaches is appropriate for every case. The surgeon must consider a variety of factors including need to improve visual acuity, ability of the optic nerve head to withstand rise of intraocular pressure, need to achieve lower intraocular pressure postoperatively, general health of the eye, and other long-term considerations such as need to fit a contact lens, availability of care, patient reliability, and opportunity to perform a second surgical procedure. A detailed approach to the management of conjoint cataract and glaucoma is given in tabular form. In general, where glaucoma surgery is of first priority, a trabeculectomy is advised, cataract extraction being performed later. Where glaucoma surgery is not thought necessary and where the optic nerve is relatively healthy a cataract extraction without a combined procedure is preferable. Each of the previously mentioned combined procedures has specific indications which are given.