Combined Cataract and Trabeculectomy Surgery

Abstract

When the decision has been made to perform cataract surgery in a glaucoma patient, the options of cataract surgery alone or combined with glaucoma surgery (glaucoma triple procedure) are available to the surgeon. Trabeculectomy is the glaucoma procedure that has been most frequently and for the longest time combined with cataract surgery, to assist in the control of intraocular pressure (IOP). Other combined procedures are discussed in Chapter 14 and elsewhere in the text. As discussed throughout the text, cataract and glaucoma often present in the same patient and are common comorbidities. The presence of a cataract may drive the decision for combined surgery, and on the other hand, a need for lower intraocular pressure (IOP) may drive the decision for a combined procedure. If the surgeon deems it is likely that the patient will need to return to the operating room for a cataract surgery, following the trabeculectomy, it may be best to perform both surgeries at the same operative session. Progression of cataract is a known complication of trabeculectomy.1,2 One surgical experience may be the best for a patient, depending on their health status and socioeconomic concerns. The status of the glaucoma and the target intraocular pressure are the important factors to consider in deciding to pursue a combined cataract extraction and glaucoma procedure versus a cataract procedure alone.3 The patient is likely to have more IOP lowering with a combined versus a cataract extraction alone.4,5 This has been shown since the initiation of the combined procedure. Trabeculectomy was originally combined with extracapsular cataract extraction (ECCE) with a 11-mm wound, as