COBINED PHACOEMULSIFICATION, INTRAOCULAR LENS IMPLANTATION, AND TRABECULECTOMY

Abstract

The management of patients with coexisting cataract and glaucoma is a common and challenging clinical problem. Coexisting cataract and glaucoma can be managed with one of three basic surgical approaches (1) cataract surgery alone, (2) trabeculectomy alone, or (3) combined cataract extraction and trabeculectomy.

In the past, each of the three management strategies had maJor drawbacks. When glaucoma surgery alone was performed as the initial procedure, cataract usually progresses and approximately 30% of the blebs failed after cataract surgery. When cataract alone was performed as the initial procedure, post-operative pressure spikes were common and the I.O.P was often difficult to control in the post-operative period, also subsequent glaucoma surgery did poorly in the scarred conjunctiva at the superior limbus. When combined cataract and glaucoma surgery was performed, the filter usually failed after a few months because of the cataract associated inflammation.

Recent advances m phacoemulsification techniques, wound

-•- construction, foldable I.O.L design, releasable sutures, and pharmacological modulation of wound healing have come together to revolutionize the . surgical management of coexisting. cataract and glaucoma and have made the combined procedure a more viable option than in the past.