The management of eyes with both cataract and glaucoma is reviewed. An argument is made for the use of combined cataract and glaucoma surgery as the initial procedure in eyes that have glaucoma, regardless of preoperative control, with cataract which requires removal. The combined operation is also recommended in eyes that require glaucoma surgery and have significant cataract (i.e. visual acuity of 6/12 or reading 6 pt print). A comparison of the results of a modified combined procedure with those of an initial cataract or glaucoma procedure followed by a second procedure at a later date and with those of previous combined procedures demonstrates the advantages of the former. The combined trabeculectomy and cataract extraction is modified by the use of a fornix-based conjunctival flap and by tightly suturing the lamellar trabeculectomy scleral flap to its base. The advantage of this technique is that a 3 1/2-year follow-up demonstrates a lower risk of postoperative complications compared with combined trabeculectomy with a loosely-sutured or unsutured scleral flap which has the same risk of postoperative complications, including shallow or flat anterior chamber, as do combined classical filtering procedures (thermal sclerostomy, trephination, sclerectomy, iridencleisis). We have reviewed 46 eyes operated by this technique and followed them for an average of 3 1/2 years. In 44 eyes the postoperative intraocular pressure is well controlled and the visual fields remain stable.