[Combined interventions: cataract and glaucoma review of the literature]

Abstract

The combined surgical treatment of cataract and glaucoma has a long and controversial history. It changed dramatically over these two last decades with the technologic advances of both cataract and glaucoma surgery which have enabled to minimize the incidence and severity of complications and greatly influenced indications for combined surgery. During the 80's, extensive studies have shown the efficacy of combined trabeculectomy with extracapsular cataract extraction (ECCE) and posterior chamber lens implantation in patients with coexisting cataract and glaucoma. Small-incision cataract surgery by phacoemulsification with foldable introcular lenses have shortly replaced the ECCE in the beginning of the 1990's and have been, with pharmacologic modulation of wound healing for glaucoma filtering surgery, the most important factors which have contributed to a higher success rate and the actual relative safety of combined procedures. As compared to cataract extraction alone, the combined procedures offer better protection against the risk of early postoperative intraocular pressure increase, as well as the hope of better long-term intraocular pressure control. Although long-term intraocular pressure control has not been as predictable with combined surgery as in the two-stage approach, the recent use of antimetabolites (such as Mitomycin C) appeared to have improved early filtration success significantly. Conversely, combined operations tend to have a larger postoperative rate of complications than in cataract extraction alone. Having regard to the large variations in methods of patients selection, procedures evaluation, and criteria for success among the different authors, we will summarize the functional results, short and long-term intraocular pressure control and complications following combined procedures.