Impact of Lens Thickness on Outcomes After Cataract Versus Combined Cataract–Glaucoma Surgery in a Predominantly Black Population

Background/Objectives: We aimed to evaluate the relationship between lens thickness (LT) and postoperative outcomes following cataract surgery versus combined cataract–glaucoma procedures in a predominantly Black and Caribbean population, and to assess the utility of LT and the Laroche Glaucoma Risk Calculator in predicting intraocular pressure (IOP) reduction. Methods: This retrospective cohort study included 187 eyes from patients aged ≥50 years that underwent cataract surgery alone or combined cataract–glaucoma surgery (goniotomy or Ahmed retrobulbar/intraconal tube) at a single center in Queens, New York. Preoperative and ≥3-month postoperative data included IOP, visual acuity (logMAR), medication burden, visual field mean deviation, and anterior segment biometry. Patients were stratified by surgical type, diagnosis, and glaucoma risk. Associations between LT and postoperative IOP reduction were analyzed. Results: Mean LT was 4.53 mm. Greater LT was associated with increased postoperative IOP reduction across all groups. Eyes with LT ≥4.5 mm showed greater IOP reduction compared to LT ≤4.2 mm (2.63 vs. 1.19 mmHg). Combined procedures yielded greater IOP reduction than cataract surgery alone, with the largest decrease in the Ahmed group (−4.56 mmHg). Cataract surgery alone produced smaller but significant reductions (−1.58 mmHg) and the greatest visual acuity improvement. Medication burden decreased substantially in the combined groups. Patients with angle-closure glaucoma had the highest LT. High-risk patients demonstrated greater IOP reduction than low-risk patients. Conclusions: Increased LT may serve as a predictive biomarker for postoperative IOP reduction. Incorporating LT and the Laroche Glaucoma Risk Calculator into preoperative planning may enhance surgical decision-making and outcomes, particularly in underserved populations.