Authors' objectives:

Cataract and glaucoma are ocular diseases that often coexist, with prevalences over age 40 of 20 percent and two percent, respectively. There is no agreement concerning their optimal management when coexistent. We prepared this evidence report to: identify the important questions pertinent to surgical treatment of coexisting cataract and glaucoma; assess the quality and content of evidence on surgical treatment of coexisting cataract and glaucoma; and inform clinical practitioners and identify areas for future research.

Authors' results and conclusions: There was strong evidence that glaucoma surgery is associated with an increased risk of postoperative cataract; moderately strong evidence that mitomycin-C, but not 5-fluorouracil is beneficial in combined procedures, limbus- and fornix-based conjunctival incisions are equally effective for lowering intraocular pressure (IOP), and the size of the phacoemulsification incision is not important; and weak evidence that combined procedures using phacoemulsification rather than nuclear expression result in lower long-term IOP, as do two-site compared to one-site combined procedures. Limitations of the literature included lack of optic nerve and visual field data, lack of objective description of the ocular lens, inconclusive information on complications, lack of patient preference and quality of life data, and limited followup in many studies.

Authors' recommendations: The literature does not point to one optimal strategy for controlling IOP in patients with coexisting cataract and glaucoma needing surgery. Therefore, there is a continued need for high quality studies with greater duration and more information on optic nerve and visual field findings.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/epcix.htm

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)