title: Surgical strategies in patients with cataract and glaucoma.
abstract: OBJECTIVE
  This review analyzes the most relevant studies on current surgical strategies to treat glaucoma patients with cataracts.
  
  
  RESULTS
  No clear evidence has confirmed better results with trabeculectomy alone compared with phacotrabeculectomy. Recent studies have reported successful outcomes combining deep sclerectomy and two-site phacoemulsification. The phacoemulsification cataract extraction will not vary the intraocular pressure of patients with previous deep sclerectomy. Mitomycin C proved to be effective in maintaining lower pressure levels with the combined surgery technique; however, 5-fluorouracil did not show any improvement. Minimally invasive cataract surgery reduces surgical trauma, making it possible to obtain better results with combined surgery and previous glaucoma surgery.
  
  
  CONCLUSIONS
  The surgical strategy decision must be customized to every patient. Only filtering surgeries are recommended in glaucoma patients with incipient cataract. Combined surgical procedures are recommended for progressive or advanced glaucoma. Two-site phacotrabeculectomy with mitomycin C achieves better stabilized results; however, combined phacoemulsification with deep sclerectomy or viscocanalostomy achieves similar results with a lower rate of complications. These promising findings need more study to be confirmed.
authors.affiliation: Institut Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain. cverges@cverges.com
authors.forename: Carlos
authors.initials: C
authors.lastname: Verges
authors.forename: Jorge
authors.initials: J
authors.lastname: Cazal
authors.forename: Cosme
authors.initials: C
authors.lastname: Lavin
mesh_terms: D002386:Cataract / Q000150:complications / Q000628:therapy*; D005901:Glaucoma / Q000150:complications / Q000601:surgery*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D018918:Phacoemulsification / Q000379:methods*; D014130:Trabeculectomy / Q000379:methods*