Evidence Table 1.  Overall summary of the literature on treatment of coexisting cataract and glaucoma.

Advanced Glaucoma Intervention Study, The, 1998

United States

	RCT	To report separately for black and white patients with advanced glaucoma 7 year results of 2 alternative surgical intervention sequences.	776	0.58	NR	Acute IOP;

Long-term IOP;

Cataract	24 months or longer	No masking 	70	Data support the use of 

argon laser trabeculoplasty-

trabeculectomy-

trabeculectomy sequence for black patients, but trabeculectomy-argon laser trabeculoplasty- trabeculectomy sequence  for white patients without life-threatening health problems.

Anand, Menage, Bailey, 1997

Europe

	Cohort	To compare visual outcomes and complications among 3 methods of combined cataract and glaucoma surgery.	132	0.00	78.7	Acute IOP;

Long-term IOP;

Complications;

Postoperative visual acuity	6 to 11 months	Minimal or no inclusion/exclusion details;

No masking; Important/unknow n baseline differences; 

Little or no surgical details	28	No differences were seen in IOP control when comparing 1-site ECCE, 1-site phacoemulsification, and 2-site ECCE procedures. PCO requiring YAG was less common in the phacoemulsification group.

Anders, Pham, Holschbach 

et al., 1997

Europe

	RCT	To determine if a radial incision could lead to a lasting decrease in IOP and the development of filtering blebs after combined phacoemulsification and filtering surgery versus cataract extraction alone.	85	NR	76.5	Acute IOP;

Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	Minimal or no inclusion/exclusion details;

No masking	67	The combined procedure lowered IOP, so did cataract surgery alone, but not as much.

Arnold, 1996

United States

	Cohort	To compare glaucoma control in patients receiving no stitch phacoemulsification/ trabeculectomy versus patients receiving a 2 stitch phacoemulsification/ trabeculectomy.	40	NR	NR	Acute IOP;

Long-term IOP;

Complications;

Postoperative visual acuity	NR	Baseline info poor; 

No masking;  Important/unknow n baseline differences 	37	Similar results were obtained for group with no stitch compared to 2 stitch procedure. However, more postoperative complications were observed in the 2 stitch group. Due to design issues generalizeability of these results is limited.

Asamoto, Yablonski, 1993 United States

	Clinical series	To determine if reforming the anterior chamber with air leads to higher rates of cataract after trabeculectomy.	173	0.18	62.2	Long-term IOP;

Cataract;

Complications	24 months or longer	N/A	N/A	Intraoperative use of air to reform the anterior chamber in trabeculectomy is associated with significantly higher rates of anterior subcapsular cataract.

Bellucci, Perfetti, Babighian et al., 

1997

Europe

	Cohort	To compare trabeculectomy alone with phacoemulsification/

trabeculectomy.	300	NR	63.5	Long-term IOP;

Cataract;

Complications	NR	Minimal or no inclusion/exclusion details; Important/unknow n baseline differences; Differences in followup or no details	21	Phacoemulsification/

trabeculectomy seemed to be their choice for cataract/glaucoma patients.

Bellucci, Luraschi, 1998 Europe

	NRCT

	To compare long-term glaucoma control in 1- site versus 2-site combined phacoemulsification/

trabeculectomy.	20	NR	75.5	Acute IOP;

Long-term IOP	6 to 11 months	Minimal or no inclusion/exclusion details	24	IOP control was similar in both groups at 2 years postoperatively but patients in 1-site group required more glaucoma medications.  However, this non-randomized study evaluated a small number of patients.

Berestka, Brown, 1997

United States

	Cohort	To compare limbus-based versus fornix-based conjunctival flaps with 1-site phacoemulsification/

trabeculectomy using MMC.	52	0.00	76.0	Long-term IOP;

Complications	NR	No masking; Important/unknow n baseline differences	48	This is a review of combined cases with higher incidence of PC rupture using limbus-based flaps.  Otherwise, results appear similar but surgical procedure and length of followup were different between the groups.

Blondeau, Phelps, 1981

United States

	RCT	To compare the efficacy and safety of trabeculectomy and thermosclerostomy for the treatment of open angle glaucoma.	98	0.15	59.7	Long-term IOP;

Cataract;

Complications;

Postoperative visual acuity	24 months or longer	No masking 	75	Although trabeculectomy is slightly less effective than thermosclerostomy in lowering pressure, its relative freedom from complications make it a more desirable filtering operation.

Bloomberg, 1996 United States

	Clinical series	To study the safety and effectiveness of a combined modified trabeculectomy and trabeculotomy with no stitch cataract surgery.	NR	NR	NR	Long-term IOP;

Complications	24 months or longer	N/A	N/A	Trabeculectomy/

trabeculotomy with no stitch phacoemulsification was both safe and effective in this series of 100 patients.

Bobrow, 1998

United States

	RCT	To assess long-term IOP control with cataract extraction combined with trabeculectomy versus cataract extraction alone.	70	0.14	70.0	Acute IOP;

Long-term IOP;

Complications;

Postoperative visual acuity	24 months or longer	No masking 	82	Both ECCE/IOL and ECCE/IOL with trabeculectomy lower IOP chronically but the latter is more effective.

Borggrefe, Lieb, Grehn, 1999

Europe

	RCT	To compare a 1-site versus a 2-site approach to phacoemulsification/

trabeculectomy.	50	NR	74.3	Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	None	64	Both 1-site and 2-site techniques of combining trabeculectomy and phacoemulsification/

IOL placement are safe and effective to lower IOP and improve VA.

Budenz, Pyfer, Singh et al.,

1999

United States

	Cohort	To estimate the effect of MMC and 5-FU on success of IOP control in phacoemulsification/

trabeculectomy.	78	0.37	74.3	Long-term IOP;

Complications;

Postoperative

visual acuity	12 to 23 months	No masking 	58	MMC was equal to no antifibrosis, except better than 5-FU in IOP postoperatively.  African-Americans did worse postoperatively compared to others in this retrospective study.

Burratto, Ferrari, 1990

Europe

	Clinical series	To assess IOP, visual acuity, and visual fields after ECCE/IOL for patients with cataract and glaucoma and prior filtering procedure.	104	NR	NR	Long-term IOP;

Complications;

Postoperative

visual acuity	6 to 11 months	N/A	N/A	ECCE/IOL does not appear to worsen the IOP control of previously existing filters with cataract status post filtering procedure without worsening of IOP.

Calissendorff, Hamberg-Nystrom, 1992

Europe

	Clinical series	To assess long-term IOP control after ECCE/IOL in glaucomatous eyes.	113	NR	77.0	Long-term IOP	24 months or longer	N/A	N/A	ECCE/IOL has a beneficial effect on IOP in glaucoma patients.

Caprioli, Park,  Weitzman, 1996

United States

	Cohort	To determine IOP lowering effects of combined phacoemulsification and superior trabeculectomy with trabeculectomy alone.	80	0.04	74.8	Acute IOP;

Long-term IOP;

Complications;

Postoperative

visual acuity	12 to 23 months	No masking 	83	IOP control was better with trabeculectomy alone than with combined phacoemulsification procedure.

Caprioli, Park, Kwon et al., 1997

United States

	Case control	To evaluate the effect of temporal clear corneal phacoemulsification on IOP in eyes that had prior trabeculectomy.	80	0.08	71.8	Long-term IOP;

Complications;

Postoperative

visual acuity	24 months or longer	N/A	N/A	Temporal clear corneal phacoemulsification in eyes with prior filtering blebs does not adversely effect IOP after one year of followup.

Carlson, Alward, Barad et al., 1997

United States

	RCT	To evaluate the effectiveness of MMC during combined phacoemulsification/

trabeculectomy with regard to IOP control and medication use postoperatively.	29	0.03	72.6	Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	Important/unknow n baseline differences	79	MMC in 1-site combined procedures produced consistently lower IOP in this small study with one-year of followup. Complications were similar in the MMC and placebo groups.

Chen, Weaver, Budenz et al., 1998

United States

	Clinical Series	To examine the effect of cataract extraction on IOP in eyes with preexisting trabeculectomy.	115	0.15	68.9	Long-term IOP;

Complications;

Postoperative visualacuity	12 to 23 months	N/A	N/A	Over 90% of patients undergoing either ECCE or PECE with existing filtering blebs were able to maintain IOP control with either no additional medicine, additional medicine, or bleb needling.  It is not clear how this compares to a population of patients with filtering blebs who did not have cataracts removed.

Cheung, Wright, Murali et al., 1997

United States

	Clinical series	To evaluate 1 to 3 years visual and IOP outcomes for trabeculectomy with MMC.	157	0.01	67.8	Acute IOP;

Long-term IOP;

Cataract;

Complications

	12 to 23 months	N/A	N/A	In a predominantly white population, many of whom had cataract extraction or previous failed trabeculectomy, success rates of MMC trabeculectomy by life table analysis were 94% at 1 year, 92% at 2 years, and 89% at 3 years.

Chia, Goldberg, 1998

Australia

	Cohort	To compare ECCE/ trabeculectomy with phacoemulsification/ trabeculectomy, 1-site.	100	NR	75.7	Long-term IOP;

Complications

	12 to 23 months	No masking	50	ECCE combined procedures had more complications and produced less IOP-lowering than phacoemulsification, but the study used historical controls.

Cinotti, Fiore, Maltzman et al., 1998

United States

	Clinical series	To assess the safety of performing ECCE/IOL in patients with glaucoma.	160	NR	74.7	Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	N/A	N/A	IOP decreased after ECCE and slowly returned to baseline at 2 years, and patients required less glaucoma medication.

Cohen, 1990

United States

	Cohort	To compare IOP control with versus without 5-FU during combined ECCE/IOL and filtering surgery.	44	0.14	74.3	Acute IOP;

Long-term IOP;

Complications

	6 to 11 months	No masking; Differences in followup or no details	61	5-FU group had no better postoperative IOP control than group without 5-FU.

Cohen, Greff, Novack et al.,

1996

United States

	RCT	To study the efficacy and safety of MMC in patients undergoing trabeculectomy and phacoemulsification.	71	0.18	76.0	Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	None	69	MMC use was associated with greater postoperative IOP control than placebo. However, more complications were observed with group receiving MMC.

Collaborative Normal-Tension Glaucoma Study Group, 1998a

United States

	RCT	To compare glaucomatous progression with versus without treatment to lower IOP in patients with normal tension glaucoma.	140	0.05	65.9	Cataract;

Complications	24 months or longer	No masking	67	Cataracts occurred more often in patients who had glaucoma surgery than in those not treated or treated medically.

Collaborative Normal-Tension Glaucoma Study Group, 1998b

United States

	RCT	To assess effectiveness of IOP reduction in treatment of normal tension glaucoma.	145	NR	NR	Cataract;

Complications	24 months or longer	No masking	67	Followup of previous study, included 5 more eyes in the treatment group, which are not characterized. More cataract in trabeculectomy patients.

Costa, Smith, Spaeth et al.,

1993

United States

	Case control	To determine the incidence and etiology of visual acuity loss within 3 months of trabeculectomy.	84	0.12	68.0	Long-term IOP;

Cataract;

Complications;

Postoperative visual acuity	3 to 5 months	N/A	N/A	Lens opacity was the main cause of early visual acuity loss after trabeculectomy.

Crandall, 1991

United States

	Clinical series	To examine the outcomes and complications of combined phacoemulsification/

trabeculectomy.	100	0.02	70.4	Complications 

	12 to 23 months	N/A	N/A	Phacoemulsification plus trabeculectomy may be satisfactory in patients with cataract and glaucoma.

Crestani, 

De Natale, Steindler, 1997

Europe

	Cohort	To compare the use of a punch during combined procedures to force excision of a cornea-scleral block. 	NR	NR	65.0	Long-term IOP;

Postoperative visual acuity	NR	Minimal or no inclusion/exclusion details;  Important/unknow n baseline differences; Little or no surgical details; 

Differences in followup or no details	3	This small series of patients showed similar IOP results with punch as with "Cairns" technique.

Dastur, 1994

Bombay, India

	NRCT	To evaluate the efficacy of early trabeculectomy in early chronic simple glaucoma.	140	NR	59.7	Long-term IOP;

Cataract;

Postoperative visual acuity	24 months or longer	No masking; Important/unknow n baseline differences	44	Early trabeculectomy for chronic simple glaucoma resulted in large reductions of IOP, reduced the size of optic disc cupping and decreased visual field loss.

Demailly, Kretz, 1992

Europe

	RCT	To compare the effectiveness of Daunorubicin versus 5-FU on IOP control, visual acuity, and complications following trabeculectomy.	27	NR	51.2	Long-term IOP;

Cataract;

Complications

	6 to 11 months	No masking; Differences in followup or no details	35	Results were similar between the two drugs. However, the small sample size of the study limits the usefulness of the results.

Derick, Evans, Baker, 1998

United States

	Cohort	To compare results of combined phacoemulsification/

trabeculectomy plus MMC versus trabeculectomy plus MMC.	84	0.11	74.9	Acute IOP;

Long-term IOP;

Cataract;

Complications;

Postoperative visual acuity	12 to 23 months	No masking; Important/unknow n baseline differences	63	Success rate for combined phacoemulsification/

trabeculectomy approaches that of trabeculectomy alone.

Donoso, Rodriguez, 2000

Chile

	Case control	To compare phacoemulsification after prior trabeculectomy to combined phacoemulsification and trabeculectomy.	40	NR	76.5	Long-term IOP;

Complications

	12 to 23 months	N/A	N/A	IOP control was the same in combined phacoemulsification/

trabeculectomy as in sequential trabeculectomy and later phacoemulsification.

El-Sayyad, Helal, El- Maghraby 

et al., 1999

Saudi Arabia

	RCT	To compare 1-site and 2-site combined phacoemulsification with foldable IOL and trabeculectomy.	76	NR	65.5	Acute IOP;

Long-term IOP;

Complications;

Postoperative visual acuity	NR	No masking	61	Two-site approach resulted in slightly better IOP, but required moving the microscope twice during surgery.  However, the 2-site group was on slightly more medication at one year.

El-Sayyad, Helal, Khalil et al., 1999

Saudi Arabia

	Case control	To compare two-stage trabeculectomy/

phacoemulsification to one-stage phacoemulsification/

trabeculectomy.	106	0.24	50.1	Long-term IOP;

Complications;

Postoperative visual acuity	NR	N/A	N/A	One-stage and two-stage phacoemulsification/ trabeculectomy gave similar IOP control.

Gandolfi, Vecchi, 1997

Europe

	RCT	To compare long-term IOP control in phacoemulsification/

trabeculectomy with 5-FU compared to without 5-FU.                             	24	NR	63.0	Long-term IOP;

Complications	12 to 23 months	Baseline info poor;  Important/unknow n baseline differences 	62	Using the two highest measurements of IOP by diurnal testing, adding 5-FU injections postoperatively improved the success of 2-site combined procedures in this small RCT with no obvious increase in adverse events.

Gayton, Van der Karr, Sanders, 1996

United States

	Cohort	To compare in a retrospective study two different incisions for combined procedure.	115	NR	75.5	Long-term IOP	12 to 23 months	Baseline info poor; No masking;  Important/unknow n baseline differences 	31	No large difference noted between 2-site phacoemulsification/

trabeculectomy surgeries.

Gayton, Van der Karr, Sanders, 1999

United States

	RCT	To study the effect of cataract surgery with endoscopic laser cycloablation versus cataract surgery combined with filtering surgery in inflammation.	58	0.40	NR	Long-term IOP;

Complications

	NR	No masking;  Important/unknow n baseline differences 	50	Trabeculectomy consistently resulted in greater success on fewer medications than endoscopic laser, but hyphema and immediate postoperative inflammation were greater in the trabeculectomy group. Outliers may have influenced the results.

Gianoli, Schnyder, Bovey et al., 1999

Europe

	RCT	To compare the outcome of two combined procedures: phacoemulsification/d eep sclerectomy and phacoemulsification/ trabeculectomy.	60	NR	80.1	Long-term IOP;

Complications;

Postoperative visual acuity0	12 to 23 months	No masking;

Differences in followup or no details	59	IOP lowering was similar in phacoemulsification/ trabeculectomy and phacoemulsification/ deep sclerectomy, with fewer short- term complications in the latter.

Gimbel, Meyer, DeBroff et al., 1995

Canada

	RCT	To compare IOP control with combined phacoemulsification  and trabeculotomy ab externo versus phacoemulsification alone.	106	NR	76.5	Acute IOP;

Long-term IOP;

Complications	12 to 23 months	No masking 	63	Combined phacoemulsification and trabeculotomy ab externo is an option to lower IOP and decrease the use of glaucoma medications in patients with POAG and cataracts.

Gunning, Greve, 1991 Europe

	Clinical series	To determine the results of one technique of cataract extraction and IOL implantation in patients with versus without glaucoma.	102	NR	75.2	Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	N/A	N/A	Cataract extraction has a beneficial effect on IOP in glaucoma.

Hayashi, Hayashi, Nakao et al., 2000

Asia (Japan)

	Cohort	To assess angle and IOP changes in ACG, OAG and non- glaucomatous individuals undergoing phacoemulsification.	224	NR	73.0	Long-term IOP	12 to 23 months	None	50	IOP decreased about 20% after clear cornea phacoemulsification in individuals with ACG and OAG.  Also, the width and depth of the AC angle in eyes with ACG increased significantly after phacoemulsification.

Hennis, Stewart, 1991

United States

	RCT	To evaluate the safety and efficacy of a 14-day course of daily 5-FU injections following combined trabeculectomy.	32	0.77	71.7	Long-term IOP;

Complications;

Postoperative visual acuity	3 to 5 months	None	50	This small, underpowered study, did not detect any harm or benefit to 5-FU use in combined ECCE/ trabeculectomy.

Honjo, Tanihara, Negi et al., 1996

Japan

	Cohort	To compare different approaches combining trabeculotomy and cataract surgery.	47	NR	71.4	Long-term IOP;

Complications	NR	Minimal or no Inclusion/exclusion details; 

Baseline info poor;  Important/unknow n Baseline differences 	13	Trabeculotomy lowered pressure when combined with cataract extraction, but many still had IOP > 21.

Hugkulstone, Sadiq, Rubasingham, 1997

Europe

	RCT	To assess IOP control with standard versus heparin-coated IOLs following combined cataract and glaucoma surgery.	19	NR	80.1	Long-term IOP;

Complications	24 months or longer	Minimal or no inclusion/exclusion details; 

No masking 	56	Use of heparin-coated IOL does not adversely effect IOP control after combined cataract and drainage surgery and was associated with a greater fall in IOP at 2 years.

Hurvitz, 1993

United States

	Cohort	To report long-term results of glaucoma triple procedure phacoemulsification/

trabeculectomy, IOL with or without 5-FU and ECCE/ trabeculectomy without 5-FU.	NR	NR	76.3	Long term IOP;

Complications	12 to 23 months	No masking; Important/unknow n baseline differences	33	The decrease in IOP was marginally greater in the group receiving 

5-FU than in the group not receiving 5-FU.   However,  possible selection biases and the learning curve of the surgeon limit the conclusion.

Jayamanne, Kostakis, Phelan, 1997

Europe

	Clinical series	To examine glaucoma control in patients undergoing combined small incision cataract surgery (phacoemulsification) and trabeculectomy.

	100	NR	NR	Long-term IOP;

Complications

	6 to 11 months	N/A	N/A	Phacoemulsification/

trabeculectomy lowered IOP in most patients followed for 6-12 months.

Jerndal, Lundstrom, 1980

Europe

	Clinical series	To report outcomes in a large (early) series of trabeculectomies.	281	NR	66.0	Long-term IOP;

Cataract	24 months or longer	N/A	N/A	Trabeculectomy is a viable surgical technique to lower IOP.

Karlen, Sanchez, Schnyder et al.,

1999

Europe

	Clinical series	To study prospectively, the success rate and complications of deep sclerectomy with collagen implant.	100	0.00	71.0	Long-term IOP;

Cataract;

Complications

	12 to 23 months	N/A	N/A	Deep sclerostomy with collagen implant appears to provide reasonable control of IOP at medium term followup, with few immediate postoperative complications.

Kendrick, Kollarits, Khan, 1996

United States

	Cohort	To determine whether ab interno laser thermal sclerostomy combined with cataract surgery would be as effective as trabeculectomy combined with cataract surgery.	70	NR	78.5	Long-term IOP	NR	Minimal or no inclusion/exclusion details; 

No masking;  Important/unknow n baseline differences	20	Phacoemulsification plus Holmium ab interno sclerostomy is as effective as phacoemulsification plus trabeculectomy.

Kim, Jung, Hwang, 1998

Korea

	RCT	To compare the effects of 3 types of combined phacoemulsification/ trabeculectomy.	28	0.00	67.4	Long-term IOP;

Postoperative visual acuity	NR	No masking; Important/unknow n baseline differences	46	Three different techniques of combined cataract and glaucoma surgery all lowered IOP at 6 months.

Kitazawa, Suemori- Matsushita, Yamamoto et al.,  1993

Japan

	RCT	To determine the optimum dose of intraoperative MMC with trabeculectomy. 	22	NR	55.4	Long-term IOP;

Cataract;

Complications	6 to 11 months	No masking	73	High dose MMC yielded better control of IOP than low dose MMC but was associated with increased hypotony and cataract progression.

Kooner, Dulaney,  Zimmerman,

1988

United States

	Clinical series	To assess IOP after ECCE/IOL in glaucoma patients.	103	NR	75.3	Long-term IOP;

Complications

	NR	N/A	N/A	ECCE/IOL could be performed in this group of glaucoma patients without worsening of IOP control.

Kosmin, Wishart,  Ridges, 1997

Europe

	Cohort	To compare glaucoma control in phacoemulsification/ trabeculectomy with silicone IOL and small incision versus PMMA-IOL and large incision.	60	NR	75.5	Acute IOP;

Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	No masking	60	No large difference was seen between large incision, 1-site combined phacoemulsification/

trabeculectomy using more stitches and smaller incision 1-site combined.

Kosmin, Wishart,  Ridges, 1998

Europe

	Cohort	To compare long-term IOP control after ECCE and trabeculectomy versus phacoemulsification and trabeculectomy.	63	NR	78.5	Long-term IOP	24 months or longer	Minimal or no inclusion/exclusion details; 

No masking	50	Phacoemulsification/

trabeculectomy led to a greater likelihood of IOP control on no medications using survival analysis.  However, total IOP decrease was slightly greater in the ECCE/ trabeculectomy group.

Krupin, Feitl, Bishop, 1989

United States

	RCT	To measure short-term IOP control after cataract surgery alone or combined with posterior lip sclerectomy.	68	0.31	75.2	Acute IOP;

Long-term IOP;

Complications	24 hours or less	No masking; Important/unknow n baseline differences	54	Many glaucoma patients undergoing cataract surgery will have a large immediate IOP spike.  If combined surgery is performed, fewer do.

Lamping, Bellows, Hutchinson et al., 1986

United States

	Clinical Series	To review the outcomes of filtration surgeries performed over a 14 year period.	252	NR	NR	Long-term IOP;

Cataract;

Complications	24 months or longer	N/A	N/A	Cataract surgery was required in 30% of those undergoing glaucoma procedures at median 5 years.  More eyes experiencing postoperative hypotony requiring choroidal drainage required cataract extraction.

Lemon, Shin, Kim et al., 1998

United States

	RCT	To study the safety and efficacy of limbus-based versus fornix-based incisions in combined phacoemulsification/ trabeculectomy with MMC.	69	0.63	74.0	Long-term IOP;

Complications	NR	None	66	No differences in  postoperative IOP control or visual outcome were observed between groups receiving a limbus-based versus fornix-based conjunctival flap, with the use of MMC. Hypotony with a wound leak was more common in the limbus-based group.

Lewis, Phelps,

1984

United States

	RCT	To compare trabeculectomy and thermosclerostomy in terms of long-term 

(5 year) effect on IOP and safety.	71	NR	59.3	Long-term IOP;

Cataract;

Complications	24 months or longer	No masking	76	When compared with thermosclerostomy, trabeculectomy was significantly more likely to result in IOP control without further surgery or medications, and had significantly fewer complications.

Liu, Su, Chou 

et al., 2000

Taiwan

	Case control	To evaluate the efficacy and safety of intraoperative MMC in combined phacoemulsification/ trabeculectomy.	40	NR	69.0	Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	N/A	63	Results of this small, retrospective study indicate that use of intraoperative MMC in combined phacoemulsification/ trabeculectomy resulted in greater success of filter and fewer complications than in phacoemulsification/ trabeculectomy alone.

Lyle, Jin, 1991

United States

	Cohort	To assess the safety and efficacy of a 3mm incision phacoemulsification/

trabeculectomy, a 6mm incision phacoemulsification, and a 6mm incision phacoemulsification/

IOL/trabeculectomy.	216	NR	75.5	Acute IOP;

Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	No masking; Differences in followup or no details 	64	No significant difference between 3mm and 6mm incision groups in IOP control, but 3mm group had fewer complications and had better early postoperative visual acuity.

Mamalis, Lohner, Rand et al., 1996

United States

	Clinical series	To evaluate glaucoma control and 

complications in patients undergoing

combined phacoemulsification/ trabeculectomy.	212	NR	73.0	Long-term IOP;

Complications

	24 months or longer	N/A	N/A	Combined 1-site phacoemulsification/ trabeculectomy on average lowered IOP and improved vision.

Manoj, Chako, Khan, 2000

Europe

	Cohort	To compare IOP control between ECCE and phacoemulsification performed after prior trabeculectomy	55	NR	77.2	Long-term IOP	24 months or longer	No masking; Important/unknow n baseline differences 	33	Phacoemulsification controlled IOP better than ECCE following prior trabeculectomy in patients with POAG.  Phacoemulsification patients required no medications to control postoperative IOP. However, this is a small retrospective study.

McCartney, Memmen, Stark et al., 1988

United States

	Clinical series	To assess efficacy and safety of combined trabeculectomy and cataract extraction/ IOL	108	NR	73.0	Long-term IOP;

Complications;

Postoperative visual acuity	NR	N/A	N/A	Good vision results and IOP results were observed with ECCE/IOL plus trabeculectomy.

McGuigan, Gottsch, Stark 

et al., 1986

United States

	Cohort	To compare visual results and complications of ECCE/IOL in those with versus without glaucoma.	90	NR	70.8	Acute IOP;

Cataract;

Complications;

Postoperative visual acuity	12 to 23 months	Minimal or no inclusion/exclusion details; 

No masking 	40	Cataract surgery did not decrease need for medication in glaucoma patients.  Eyes with glaucoma had more IOP spikes in early period.

McKinzie, Boggs, 1989

United States

	Cohort	To determine whether Miochol or Miostat is more effective in controlling IOP after cataract surgery.	16	NR	NR	Acute IOP	24 hours or less	Minimal or no inclusion/exclusion details; 

No masking;  Important/unknow n baseline differences 	30	Miostat was better than Miochol at controlling acute IOP after cataract surgery.

Montgomery, Gills, 1980

United States

	Clinical series	To assess results of combined ECCE/IOL and cyclodialysis.	238	NR	NR	Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	N/A	N/A	ECCE/IOL/Cyclo- dialysis is a good operation for cataract and glaucoma.

Murchison, Shields, 1989

United States

	Cohort	To compare 3 approaches to coexisting glaucoma and cataract: 1) combined guarded filtering procedure; 2) 2-stage filtering surgery then cataract extraction; 3) cataract surgery alone.	78	NR	71.0	Acute IOP;

Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	No masking;  Important/unknow n baseline differences	44	Fewer early postoperative IOP increases observed with combined procedures than with cataract surgery alone but fewer complications with latter; similar final IOP in all 3 groups.

Murchison, Shields,  1990

United States

	Cohort	To compare limbal-based versus fornix-based conjunctival flaps in combined ECCE and glaucoma filtering procedure.	47	0.17	73.5	Acute IOP;

Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	No masking	67	Limbal-based surgery had better early postoperative IOP control than fornix-based ECCE/trabeculectomy but similar long-term IOP control and visual acuity.

Naveh, Kottass, Glovinsky et al.,   1990

Israel

	Cohort	To compare long-term IOP control with trabeculectomy plus cataract extraction (ECCE) versus trabeculectomy alone.	78	NR	71.0	Long-term IOP	12 to 23 months	No masking; Important/unknow n baseline differences	48	Postoperative IOP significantly lower after trabeculectomy than after combined trabeculectomy plus ECCE.

Neumann, Zalish, Oliver, 1988

Israel

	Cohort	To assess the effect of IOL implantation on combined ECCE with trabeculectomy.	46	NR	73.3	Acute IOP;

Long-term IOP;

Complications	6 to 11 months	No masking;  Important/unknow n baseline differences; Differences in followup or no details	34	IOP implantation did not have a detrimental effect on postoperative IOP or visual acuity, but was associated with increased minor anterior chamber reactions.

Nielsen, 1997

Europe

	NRCT	To compare two different approaches to making a trabeculectomy incision in 1-site phacoemulsification/ trabeculectomy.	26	NR	NR	Long-term IOP;

Complications	12 to 23 months	Baseline info poor; 

No masking;  Important/unknow n baseline differences	29	More hyphema and vitreous hemorrhage with a more posterior wound. IOPs were similar. Blebs appeared more "functional" with posterior wound.

Noben, Linsen, Zeyen, 1998

Europe

	Case control	To compare the IOP control of trabeculectomy versus phacoemulsification/

trabeculectomy combined.	NR	NR	72.5	Long-term IOP;

Complications	12 to 23 months	N/A	N/A	In this retrospective review, IOP was better controlled after trabeculectomy than after combined surgery.

O'Grady, Juzych, Shin et al., 1993

United States

	RCT	To study whether 5-FU increases the success of combined primary trabeculectomy and phacoemulsification surgery.	NR	NR	72.8	Long-term IOP;

Complications;

Postoperative

visual acuity	12 to 23 months	Minimal or no inclusion/exclusion details	45	Postoperative management with low dose 5-FU did not improve postoperative outcomes in patients undergoing combined trabeculectomy and phacoemulsification compared to controls and increased the rate of SPK substantially

Onali, Raitta, 1991

Europe

	Clinical series	To show short-term and long-term effects of ECCE/IOL on IOP and glaucoma control in simple glaucoma and capsular glaucoma.	103	NR	77.0	Long-term IOP;

Complications	24 months or longer	N/A	N/A	ECCE with IOL is indicated for OAG eyes with preoperatively controlled IOP although 30% of cases had a rise in IOP in the 1st to 2nd postoperative day.

Park, Weitzman, Caprioli,  1997

United States

	Cohort	To compare glaucoma control in patients receiving phacoemulsification/ trabeculectomy with 5-FU compared to patients receiving trabeculectomy alone with 5-FU.	80	0.04	74.8	Acute IOP;

Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	No masking	63	Two-site combined procedure lowered IOP, but IOPs were not as well controlled when compared with a group undergoing primary trabeculectomy.

Perasalo, 1997

Europe

	Clinical series	To examine IOP control in patients with glaucoma undergoing small incision phacoemulsification with IOP implant.	226	NR	81.6	Long-term IOP;

Complications	NR	N/A	N/A	If glaucoma is fairly well controlled, phacoemulsification alone can result in satisfactory IOP control in eyes with capsular glaucoma and POAG.

Robin, 1993

United States

	RCT	To compare acute IOP after combined glaucoma and cataract surgery with versus without apraclonidine.	109	0.07	75.0	Acute IOP;

Long-term IOP	1 week to 29 days	None	76	IOP can be high one day after ECCE/IOL/ trabeculectomy but this is less frequent if apraclonidine is used preoperatively.

Robin, Ramakrishnan, Krishnadas 

et al., 1997

India

	RCT	To establish the long-term, dose-response relationship between concentration and duration of MMC to postoperative IOP and complications.	300	NR	51.7	Long-term IOP;

Cataract;

Complications	NR	Important/unknow n baseline differences	78	IOP control tended to increase with higher concentration or longer duration of MMC, but with an increased incidence of cataract.

Rossetti, Bucci, Miglior et al., 1997

Europe

	RCT	To compare long-term IOP control between 1-site and 2-site phacoemulsification/ trabeculectomy.	50	NR	NR	Long-term IOP	NR	Minimal or no inclusion/exclusion details;  Important/unknow n baseline differences; Little or no surgical details; 

Differences in followup or no details 	11	One-site trabeculectomy appeared to have slightly worse IOP control than 2-site (with clear cornea).  However baseline demographics and ancillary treatments were not reported.

Sanders, Cantor, Dobler et al., 1999

United States

	RCT	To compare outcome of trabeculectomy using either 0.2 mg. or 0.4 mg. MMC.	50	0.12	72.5	Acute IOP;

Long-term IOP;

Cataract;

Complications;

Postoperative visual acuity	6 to 11 months	None	88	Low dose (0.2) as effective as high dose (0.4) MMC in eyes with previous surgery, with slightly fewer complications.

Savage, Thomas, Belcher et al.,  1985

United States

	Cohort	To assess results of ECCE with or without IOL in patients with and without glaucoma.	296	NR	NR	Long-term IOP;

Complications	NR	No masking;  Important/unknow n baseline differences; Differences in followup or no details 	29	Implantation of IOL did not influence postoperative IOP.  Open angle glaucoma developed in 1.4% of normal eyes after ECCE/IOL.

Shin, Kim, Ren et al., 1998

United States

	RCT	To report the effect of intraoperative MMC on the incidence of PCO requiring YAG-capsulotomy in combined trabeculectomy/

phacoemulsification.	174	0.50	74.5	Complications	24 months or longer	None	78	Intraoperative application of MMC decreases the risk of developing PCO requiring YAG.  No information was provided on complications or postoperative IOP.

Shin, Ren, Juzych et al., 1998

United States

	RCT	To compare filtration success using MMC in primary glaucoma triple procedure versus none.	197	0.51	74.3		24 months or longer	None	78	MMC in combined cases appears to increase the likelihood of "success" in blacks, individuals with high preoperative IOP, and those on multiple medications.

Shin, Kim, Sheth et al., 1998

United States

	RCT	To compare glaucoma control using MMC for secondary glaucoma triple procedures to using no antimetabolite.	49	0.65	68.3		24 months or longer	Minimal or no inclusion/exclusion details	53	MMC appeared to increase the "success rate" over no antifibrosis in secondary glaucoma triple procedures.

Shingleton, Jacobson, Kuperwaser,

1995

United States

	Cohort	To compare IOP reduction in patients receiving combined ECCE/trabeculectomy versus combined phacoemulsification/ trabeculectomy.	72	0.00	76.5	Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	No masking;  Important/unknow n baseline differences	46	Phacoemulsification combined with trabeculectomy resulted in slightly better postoperative IOP control compared to ECCE/

trabeculectomy.

Shingleton, Chaudhry, O'Donoghue 

et al., 1999

United States

	NRCT	To compare outcome of limbus versus fornix-flap phacoemulsification/

trabeculectomy.	88	0.00	75.4	Long-term IOP;

Complications;

Postoperative visual acuity	NR	Minimal or no inclusion/exclusion details	63	Similar IOP control and complications with fornix and limbus-based phacoemulsification/

trabeculectomy.

Shingleton, Gamell, O'Donoghue 

et al., 1999

United States

	Cohort	To study the effect of corneal phacoemulsification on "glaucoma" (IOP).	310	NR	73.3	Acute IOP;

Long-term IOP;

Complications;

Postoperative visual acuity	NR	No masking; Important/unknow n baseline differences	59	Corneal phacoemulsification lowers IOP (but no decrease in medications was seen preoperatively).

Spaeth, 1980

United States

	RCT	To compare effectiveness and safety of trabeculectomy and full thickness procedure.	30	NR	NR	Long-term IOP;

Cataract;

Complications	24 months or longer	Minimal or no inclusion/ exclusion details; 

No masking;  Important/unknow n baseline differences	22	Trabeculectomy and thermal sclerostomy have similar effects and complications.

Stewart, Crinkley, Carlson,

1994a

United States

	Case control	To study IOP control and complications in phacoemulsification with trabeculectomy using a limbus-based verus fornix-based flap.	31	0.48	74.0	Long-term IOP;

Complications;

Postoperative visual acuity	NR	N/A	N/A	Both approaches yielded similar outcomes postoperatively. The limbus-based approach had slightly more complications.

Stewart, Crinkley, Carlson,

1994b

United States

	Case control	To compare postoperative IOP control and visual acuity in eyes undergoing combined phacoemulsification/ trabeculectomy to eyes undergoing ECCE/ trabeculectomy.	NR	NR	72.2	Long-term IOP;

Complications;

Postoperative visual acuity	6 to 11 months	N/A	36  	Phacoemulsification plus trabeculectomy is as effective as ECCE plus trabeculectomy in controlling postoperative IOP in this small study.

Storr-Paulsen, Pedersen, Laugesen, 1998

Europe

	RCT	To compare phacoemulsification and trabeculectomy to phacoemulsification for coexisting cataract and glaucoma.	20	NR	80.0	Acute IOP;

Long-term IOP;

Complications;

Postoperative visual acuity	6 to 11 months	No masking	72	IOP fell with phacoemulsification alone, but more with combined phacoemulsification/

trabeculectomy.  Fewer medications required after phacoemulsification/

trabeculectomy.

Tanihara, Negi, Akimoto et al., 1993

Japan

	Clinical series	To describe a modified trabeculectomy and report outcomes of this surgical technique.	439	NR	50.8	Cataract;

Complications	24 months or longer	N/A	N/A	Trabeculotomy seldom results in medication- free control of IOP, even in a group with favorable surgical prognosis.

Tezel, Kolker, Kass et al., 1997a 

United States

	Cohort	To compare limbus versus fornix-based flaps in combined phacoemulsification/ trabeculectomy.	215	0.11	75.0	Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	Minimal or no inclusion/exclusion details	40	Limbus-based and fornix-based conjunctival flaps appear to be comparable after a combined phacoemulsification/ trabeculectomy with MMC.

Tezel, Kolker, Kass et al., 1997b

United States

	Cohort	To compare long-term IOP control and visual outcomes between combined trabeculectomy with ECCE versus combined trabeculectomy with phacoemulsification.	397	0.11	76.4	Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	Minimal or no inclusion/exclusion details	48	The combination of combined phacoemulsification, releasable scleral flap sutures, and foldable IOL is the best regarding IOP control and visual acuity, compared to combined with ECCE and a rigid IOL.

Tornqvist, Drolsum, 1991

Europe

	Clinical series	To study rate of visual field progression up to 10 years after trabeculectomy.	277	NR	70.0	Long-term IOP;

Cataract;

Complications	NR	N/A	N/A	Only 42% of eyes failed to demonstrate visual field progression 10 years after trabeculectomy. A major cause of vision loss and visual field progression is cataract.  

Tuulonen, Niva, Alanko, 1987

Europe

	NRCT	To determine the long term efficacy of laser trabeculoplasty as primary therapy in simple and capsular glaucoma compared to initial medical treatment.	64	NR	63.5	Long-term IOP;

Cataract	24 months or longer	No masking	56	IOP and optic disk outcomes are significantly better for early glaucoma patients treated initially with ALT than for those treated initially with medications without the option of receiving ALT.

Vu, Shields, 1988

United States

	NRCT	To compare early postoperative IOP in glaucoma patients after ECCE/IOL versus ICCE.	50	0.08	69.7	Acute IOP	1 to 2 months	Minimal or no inclusion/exclusion details; 

No masking; important/unknow n baseline differences	36	IOP elevation common after cataract (ECCE or ICCE) surgery in glaucoma patients.

Vyas, Bacon, Percival, 1998

Europe

	NRCT	To compare IOP results after 3.5mm versus 5.2mm incision phacoemulsification/

trabeculectomy.	50	0.00	73.7	Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	No masking;  Important/unknow n baseline differences	35	No differences were observed between the 3.5mm and 5.2mm incision groups.  However fewer complications were seen with the larger incision.

Wand, 1996

United States

	Cohort	To compare the difference in IOP control using a 6.0mm incision to that using a 3.2mm incision during a 1-site combined procedure with MMC.	57	0.14	76.0	Long-term IOP;

Complications;

Postoperative visual acuity	6 to 11 months	No masking; Differences in followup or no details	57	Similar outcomes with combined  phacoemulsification/

trabeculectomy 1-site procedure with MMC using a 6.0mm incision and a 3.2mm incision. The laser incision group was operated in one year before the smaller incision group.

Watson, Jakeman, Ozturk et al., 1990

Europe

	Clinical series	To assess long-term outcomes of trabeculectomy.	150	NR	NR	Long-term IOP;

Cataract	24 months or longer	N/A	N/A	Excellent long-term IOP control with few complications. Cataracts developed or progressed in 14.3% of cases, but no control group presented for comparison.

Wedrich, Menapace, Hirsch et al., 1996

Europe

	Cohort	To compare the results of combined ECCE and trabeculectomy to combined phacoemulsification/ trabeculectomy through a small incision.	NR	NR	76.9	Long-term IOP;

Complications

	24 months or longer	Minimal or no inclusion/exclusion details; 

No masking	43	Phacoemulsification/

trabeculectomy yielded better results in this study. However, interpretation of the findings is limited by the methodology.

West, Burke, Cunliffe et al.,

1992

Europe

	RCT	To compare acetazolamide and acetylcholine for reducing acute postoperative IOP rises after cataract extraction.	36	NR	79.3	Acute IOP	24 hours or less	None	69	Combined acetazolamide and acetylcholine was most effective in controlling acute postoperative IOP.

Wilson, 1989

St. Lucia

	RCT	To compare posterior lip sclerectomy versus trabeculectomy for primary open angle glaucoma.	80	1.00	63.8	Long-term IOP;

Cataract;

Complications	24 months or longer	No masking	74	Postoperative IOP was lower and bleb more cystic after posterior lip sclerectomy than trabeculectomy with no significant difference in visual acuity but higher rate of complications. 

Wishart, Austin, 1993

Europe

	Cohort	To compare the effectiveness of phacoemulsification and trabeculectomy to ECCE and trabeculectomy.	68	NR	78.5	Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	No masking; Differences in followup or no details	54	Phacoemulsification with trabeculectomy resulted in better IOP control with many fewer complications than did ECCE with trabeculectomy.

Wong, Ruderman, Krupin et al.,

1994

United States

	RCT	To study the safety and effectiveness of 5-FU on intraocular pressure in eyes with open angle glaucoma following combined trabeculectomy and ECCE.	44	0.10	75.0	Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	Little or no surgical details	62	No differences were observed postoperatively in eyes receiving 5-FU compared to control eyes for IOP, number of medications, or visual acuity.  Use of 5-FU was associated with SPK.

Wyse, Meyer, Ruderman et al., 1998

United States

Reference No.: 97	RCT	To compare glaucoma control in 1-site versus 2-site combined phacoemulsification/ trabeculectomy.	33	NR	75.0	Long-term IOP	12 to 23 months	No masking	60	Results of this small sample study were similar in both groups with respect to IOP. 1-site group required slightly more glaucoma medications at last followup.

Yalvac, Airaksinen,  Tuulonen, 1997

Europe

	Cohort	To determine the postoperative IOP in patients with glaucoma who underwent phacoemulsification with and without trabeculectomy.	56	NR	79.0	Long-term  IOP;

Complications;

Postoperative visual acuity	NR	Important/unknow n baseline differences	46	Cataract surgery either phacoemulsification alone or combined with trabeculectomy induces significant reductions of IOP in patients with glaucoma.

Yang, Moster, Azuara-Blanco 

et al., 1997

United States

	Clinical

Series	To evaluate glaucoma control in patients undergoing combined phacoemulsification/ trabeculectomy with MMC.	182	0.12	74.5	Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	N/A	N/A	IOP decreased significantly after combined phacoemulsification/ trabeculectomy with MMC.  However, visual outcomes were worse than in a previously reported series of combined procedures.

Yu, Chong, Caesar et al., 1996

Europe

	Cohort	To compare long-term IOP control in patients undergoing a glaucoma triple procedure (ECCE, IOL implantation, trabeculectomy) to patients receiving trabeculectomy alone.	45	0.00	77.9	Long-term IOP;

Complications;

Postoperative visual acuity	12 to 23 months	No masking	65	Similar long-term results were observed for the group receiving a combined procedure and the group receiving trabeculectomy alone. Although patients were "low risk", more postoperative complications were observed in the group receiving the combined procedure.