Managing Cataract and Glaucoma in the Developing World: Manual Small Incision Cataract Surgery (MSICS) Combined with Trabeculectomy

There is a strong interrelation between surgical management of glaucoma and cataract. Performing cataract surgery alone can lower the intraocular pressure, by about 4–6 mmHg. However, in majority of the patients with glaucoma, this is insufficient to attain the target intraocular pressure. A glaucoma filtration surgery when performed alone has a higher risk of inducing cataracts, which the patient perceives as worsening of vision after surgery. So, when there is an operable cataract, trabeculectomy combined with cataract surgery is considered to be effective. Phacoemulsification requires expensive capital equipment, costly disposables apart from skilled service and maintenance technicians; all of which increases the patients’ expenditure. In such circumstances, manual small incision cataract surgery could be combined with trabeculectomy giving similar outcomes. Here, we describe various steps of such a combined procedure to manage cataract and glaucoma in the developing world.