International Ophthalmology 16: 409-414, 1992. 9 1992 KluwerAcademic Publishers. Printedin the Netherlands. Combined small-incision cataract surgery and trabeculectomy - technique and results Andreas Wedrich, Rupert Menapace, Ursula Radax, Panos Papapanos & Michael Amon 1. University Eye Hospital, Spitalg 2, A-1090, Vienna, Austria Key words: glaucoma triple procedure, phacoemulsification, poly HEMA intraocular lens, small-incision cataract surgery, trabeculectomy Abstract In a prospective study 35 eyes of 25 patients with coexisting cataract and glaucoma underwent trabeculecto- my, phacoemulsification and implantation of a folded polyHema intraocular lens through the trabeculecto- my opening. Follow-up ranged from 6 to 27 months (mean 13.3). The mean age was 76.4 (68 to 88 years). 22 eyes suffered from primary open angle glaucoma, 10 eyes from a pseudoexfoliation glaucoma and 3 eyes had a chronic angle closure glaucoma. Preoperatively intraocular pressure was controlled in 10 eyes with a mean medication of 2.1 but uncontrolled in 25 eyes (mean medication: 2.5). The preoperative visual acuity ranged from 20/40 to hand motions. Postoperatively intraocular pressure was controlled (< 18 mmHg) in all (100%) eyes and without therapy in 32 (91%) eyes. Three (9%) eyes had to be treated with topical timolol twice a day after surgery. Mean intraocular pressure dropped from 21.2+ 6.0mmHg preoperatively to 13.5_+ 2.1 mmHg postoperatively. Vision improved in all but 4 eyes, 25 (74%) achieving a visual acuity of 20/40 or better. The causes for failed improvement or deterioration of vision were senile macular degeneration in 2 eyes and central retinal vein occlusion and vascular optic nerve atrophy in one eye respectively. Post- operative complications included hyphema in 9 (26%) eyes, fibrin effusion to a various extent into the anterior chamber in 19 (54%) eyes and delayed hypotony (< 5 mmHg) with chorioidal effusion in 1 (3%) eye. Fibrin effusion was frequently observed in eyes with intraocular pressure below 10 mmHg, iris surgery and hyphema. Finally the complications did not effect the results regarding visual acuity or glaucoma control. In summary we conclude that the combination of small-incision cataract surgery and trabeculectomy is an effective surgical approach to obtain visual rehabilitation and glaucoma control with one single surgical intervention. Introduction In the management of coexisting cataract and glau- coma the combination of cataract surgery with a glaucoma filtering procedure has been increasingly recognized over the past decade. Several studies reported encouraging results regarding visual re- covery and glaucoma control with short [1], medi- um [2-4] and long-term [5] follow-ups. So far the combination of an extracapsular cataract extrac- tion and a PMMA posterior chamber lens implan- tation with a trabeculectomy has been commonly performed. Yet with this technique the trabeculec- tomy incision has to be enlarged for nucleus deliv- ery up to a length of 10 to 12mm. With the up- coming of phacoemulsification for the removal of the lens the incision size could be reduced to 6 to 7 mm necessary for the implantation of a PMMA intraocular lens, but still the trabeculectomy in- cision has to be enlarged and sutured after the