Abstract
This article describes the changing treatment of co-existent cataract and glaucoma over the past 70 years. Seventy years ago, the cataract was removed using an intracapsular technique. Glaucoma was always controlled with a scleral fistulizing operation before the cataract was removed. In 1975, Charles Kelman introduced phacoemulsification. When clear corneal incisions were introduced for phacoemulsification, glaucoma surgery no longer needed to precede cataract surgery. The combined procedure of phacoemulsification/lens implantation and trabeculectomy became popular 10 years ago. Recently, non-bleb treatments for glaucoma have emerged that eliminate the problems associated with trabeculectomy. These procedures include phaco/intraocular lens (IOL) alone, trabectome, iStent®, and canaloplasty. A major cause of adult glaucoma, the enlarging crystalline lens as it ages, was recognized in 2007. Greater IOP reductions following phaco/IOL alone were discovered at this time. Phaco/IOL may emerge as the preferred treatment of co-existent cataract and glaucoma. Trabectome can be added to phaco/IOL if greater IOP reduction is needed.
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