[Glaucoma and cataract--surgery at two times]

Cataract surgery in glaucoma patients remains a controversial subject. Indication of surgery depends on the type and severity of glaucoma. Surgical results depend on: the technique used for cataract extraction (extracapsular or phacoemulsification), the type of filtration procedure (trabeculectomy or deep sclerectomy) as well as of the site of the surgical incision, the use of antifibrotic agents and on the surgeon's experience. As cataract extraction alone reduces the intraocular pressure in glaucoma patients (especially in angle closure glaucoma) and trabeculectomy alone reduces intraocular pressure more than combined surgery with less complications, we recommend for controlled glaucoma patients cataract extraction alone and for uncontrolled glaucoma patients a two step procedure consisting in first a trabeculectomy and second a cataract extraction. The use of an antimetabolites not necessary. The recent use of topical anesthesia permits a two staged surgery with less inconvenience.