Cataract surgery after trabeculectomy: the effect on trabeculectomy function.
ABSTRACT To determine whether the timing of cataract surgery after trabeculectomy has an effect on trabeculectomy function in terms of intraocular pressure control.
This was a cohort study nested within a randomized clinical trial. There were 235 participants with glaucoma who had a single previous trabeculectomy augmented with either intraoperative 5-fluorouracil or placebo. Cataract surgery with intraocular lens implantation was performed on participants judged to have significant lens opacity. Cox regression was performed to evaluate the effect of time between trabeculectomy and cataract surgery on the time to trabeculectomy failure, after adjusting for other relevant risk factors. The main outcome measure was time to failure of trabeculectomy, defined as an intraocular pressure of greater than 21 mm Hg.
Of the 235 participants, 124 (52.7%) underwent subsequent cataract surgery. The median time from trabeculectomy to cataract surgery for these patients was 21.7 months (range, 4.6-81.9 months). The median follow-up period was 60 months (range, 28-84 months) for the cataract surgery group and 48 months (range, 12-84 months) for the non-cataract surgery group. Cox regression showed that the time from trabeculectomy to cataract surgery was significantly associated with time to trabeculectomy failure (hazard ratio, 1.73 [95% CI, 1.05-2.85]; P = .03). The adjusted declining hazard ratios for risk of subsequent trabeculectomy failure when cataract surgery was performed 6 months, 1 year, and 2 years after trabeculectomy were 3.00 (95% CI, 1.11-8.14), 1.73 (95% CI, 1.05-2.85), and 1.32 (95% CI, 1.02-1.69), respectively.
Cataract surgery after trabeculectomy increases the risk of trabeculectomy failure, and this risk is increased if the time between trabeculectomy and cataract surgery is shorter.
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ABSTRACT: This review summarizes the recent literature regarding the incidence and management of cataract following glaucoma surgery. Half of the total number of phakic patients that have either trabeculectomy or tube shunt surgery will go on to develop visually significant cataract within 5 years. Phacoemulsification following trabeculectomy is significantly associated with bleb failure and loss of intraocular pressure (IOP) control. Recent studies suggest that the risk of bleb failure increases, the earlier cataract surgery is performed, and recommend a delay of at least 1-2 years after trabeculectomy to enable the bleb to stabilize. Bleb failure occurs because of scarring secondary to postoperative inflammation. Evidence suggests that intraoperative subconjunctival 5-fluorouracil (5-FU) may be protective, and repeated postoperative 5-FU injections may have a role in high-risk individuals along with aggressive anti-inflammatory treatment. Phacoemulsification following tube shunt surgery improves vision and does not affect IOP control. Novel glaucoma procedures are emerging, but they are often combined with cataract surgery, and/or clinical studies are at an early stage. The development of visually significant cataract is common after glaucoma surgery. Subsequent cataract surgery can affect IOP control following trabeculectomy but not after tube shunt surgery. Measures to minimize the risk of bleb failure and loss of IOP control following trabeculectomy are critical in the management approach to patients who have had trabeculectomy.Current opinion in ophthalmology 01/2013; 24(1):15-20. · 2.49 Impact Factor