Laser trabeculoplasty and cataract surgery

We have compared long-term intraocular pressure control in patients with open angle glaucoma, cupping and atrophy of the optic nerve head and visual field loss as well as cataract after: trabeculectomy posterior to the scleral spur and cataract extraction without implantation in 108 patients, guarded posterior lip sclerectomy, cataract extraction and Mark VIII or Mark IX anterior chamber implantation in 28 patients, argon laser trabeculoplasty followed by lens extraction and implantation in 27 patients. Approximately 75 per cent of patients achieve intraocular pressures of 18 mm Hg or less without medication after (a), and approximately 40 per cent of patients achieve similar control without medication after (b). Approximately 25 per cent of these glaucoma patients have intraocular pressure levels of ≤18 mm Hg on topical medication three months after argon laser trabeculoplasty, and none achieve this control without medication. Cataract surgery with anterior or posterior chamber implantation caused loss of topical control in four of the seven patients benefitting from ALT. These data imply that combined surgery with or without implantation produces better and more significant intraocular pressure control than the presently utilized techniques of ALT subsequently followed by lens extraction and implantation.