When Glaucoma Meets Cataract: Where To Draw The Line?

The coexistence of glaucoma and cataract is common and poses a therapeutic dilemma: phacoemulsification alone, combined surgery (phaco + MIGS / filtration), or sequential management. The objective is to synthesize recent data from the PubMed literature and propose practical decision-making criteria.

 A review (2010–2025) of meta-analyses, randomized trials, and large cohorts identified on PubMed. Comparative reviews and analyses on MIGS and filtering surgeries were prioritized.

 A review (2010–2025) of meta-analyses, randomized trials, and large cohorts identified on PubMed. Comparative reviews and analyses on MIGS and filtering surgeries were prioritized.

Phacoemulsification alone significantly reduces IOP (often reported between ~2–4 mmHg) and frequently decreases topical therapy for 1–3 years, with a more pronounced effect in angle-closure and pseudoexfoliative glaucomas. The combination of phaco + MIGS (e.g., iStent, Hydrus) provides additional IOP reduction compared to phaco alone (modest average gain) with a favorable safety profile. Recent comparisons between devices (iStent vs Hydrus) show similar benefits at medium term. Combined phaco + filtration procedures result in the greatest IOP reduction but are associated with a higher rate of postoperative complications (hypotony, bleb fibrosis, refractive changes); the literature therefore suggests cautious patient selection.

 The boundary between cataract and glaucoma surgery is not fixed: it is drawn according to :  glaucoma severity and target IOP, angle anatomy, conjunctival status (preservation for future filtration), adherence/medication burden, and patient visual expectations.