Techniques have been described in which a trabeculotomy is performed through a radial incision at 12 o'clock adjacent to a partial-thickness corneoscleral incision before extending the incision full-thickness for the cataract surgery (28,144,145). Phacoemulsification has also been combined with holmium laser sclerostomy, using either an ab externo (146) or ab interno (147) approach, with the latter providing more IOP reduction (148). Combining phacoemulsification with endoscopic laser to perform either goniopuncture (149) or cyclophotocoagulation (150,151) through a cataract incision has also been proposed as an alternative to combined cataract and trabeculectomy surgery. Deep sclerectomy (152,153) and viscocanalostomy (154,155) combined with phacoemulsification have both been reported to achieve IOP reduction and visual acuity similar to phacoemulsification combined with trabeculectomy, but with fewer complications. A technique of combining trabecular aspiration with phacoemulsification was proposed as an alternative to combination of trabeculectomy and phacoemulsification in pseudoexfoliative glaucoma, but it did not appear to provide sufficient postoperative IOP lowering (156).
Cataract surgery has also been combined with implantation of an Ahmed (157) or Baerveldt (158) drainage implant, and is reported to be an effective method of improved IOP control in certain cases in which combined trabeculectomy has failed or has a high risk of failure, for example, when previous surgery has produced significant conjunctival scarring, or in patients with secondary glaucoma. However, complications, such as aqueous misdirection (158), corneal edema (158), choroidal effusion (158), and capsular bag distention (159), have been reported.
