Combined approach, the yield of micro incisions for cataract surgery

Cataract extraction combined with glaucoma surgery remains controversial. Some authors advocate consecutive surgeries arguing that the expected lower inflammation will allow a better outcome of the filtering surgery. However it is well known that cataract extraction after a filter may impair the long term efficacy of glaucoma surgery. Conversely the combined approach is more convenient for the patient with one operation and generally a better visual result. However it is generally considered that the IOP‐lowering effect is less effective in combined procedures. Rather than opposing these two approaches, it is probable than according to the characteristics of the patient and the type and the stage of glaucoma, a consecutive or a combined surgery is more appropriate. Therefore the surgeon must be prepared to perform the two types of surgery. Micro incisions for cataract surgery (MICS) offer some substantial advantages vs conventional corneal incisions; a better tightness of the surgical wound allows a better control of IOP during the surgery. Therefore glaucoma surgeries (penetrating or not) are much easier to perform without changing your technique. In this presentation some surgical tips will be given in order to facilitate your combined procedures.