The widely popular belief that IOP reduction from cataract surgery will benefit glaucoma does not hold for all glaucoma patients, especially patients with refractory glaucoma and advanced disc disease. In the Ocular Hypertension Treatment Study, there was significant IOP reduction, about 4 mm Hg, from cataract surgery, but these patients were only glaucoma suspects. They were not on glaucoma medications and had healthy optic discs and normal visual fields.

The popularity of phacotrabeculectomy has certainly lessened for surgeons who are proponents of simpler, less invasive blebless procedures. The trade-off is that these less invasive procedures typically do not lower IOP as much as a filtering procedure because canal procedures depend on the integrity of the resident episcleral venous outflow system.

Although the popularity of phacotrabeculectomy has waned, its place in the care of a patient with conjoint cataract and glaucoma is now better defined. We tend to reserve phacotrabeculectomy for a select group of patients. The task is to select which patients will benefit the most from this combined procedure. For that we use a simple mnemonic.