Combined cataract extraction and glaucoma surgery.

An approach to the surgical management of eyes with concomitant cataract and glaucoma is outlined, and the author's experience in 73 consecutive cases is described. Cataract extraction alone is recommended when glaucomatous damage is minimal, and the intraocular pressure is controlled with a low-dose, well-tolerated medical regimen. When the glaucoma is uncontrolled on maximum tolerable medical therapy and poses an immediate threat to vision, a two-stage procedure of filtering surgery with subsequent cataract extraction is preferred. Between these two extremes of glaucoma control are those cases for which a combined operation is felt to be indicated, especially when cataract surgery is planned in an eye with borderline glaucoma control and/or moderate to advanced glaucomatous damage. The preferred combined approach is cataract extraction with a guarded filtering procedure, and a simplified technique to accomplish this is described.