Objective: To compare surgical results between 3.2- and 6.0-mm incisions in combined phacoemulsification, intraocular lens implant, and trabeculectomy with intraoperative mitomycin-C.

Methods: Fifty-seven consecutive eyes of 45 patients in a referral practice underwent combined phacoemulsification, intraocular lens implant, and trabeculectomy with intraoperative mitomycin-C. The first 24 eyes had a 6.0-mm incision and the next 33 eyes had a 3.2-mm incision; the procedures were otherwise identical. The postoperative intraocular pressures, number of antiglaucoma medications, presence of filtration blebs, visual acuity, and complications at 1 day, 1 week, 1 month, and 1 year were subjected to multivariate analysis.

Results: There were no statistical differences in the intraocular pressure control, number of antiglaucoma medications, or presence of filtration bleb between the two groups at any of the postoperative visits. Visual acuity was significantly better (p = 0.02) for the 3.2-mm incision group throughout the evaluation period.

Conclusions: Both large- and small-incision phacoemulsification, intraocular lens implant, and trabeculectomy with intraoperative Mitomycin-C provide good intermediate range (1 year) postoperative IOP in eyes with coexisting cataract and glaucoma. In addition, small-incision surgery results in earlier and better visual rehabilitation than large-incision surgery.