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May 2001

Cataract Extraction and Hypotony After Trabeculectomy

Arch Ophthalmol. 2001;119(5):783. doi:

We read with interest the report by Drs Doyle and Smith1 on the effect of phacoemulsification on hypotony following trabeculectomy. They are to be congratulated on their positive outcomes in 9 eyes with an intraocular pressure (IOP) of 6 mm Hg or lower prior to phacoemulsification. In 1998, we investigated the outcome of cataract extraction on trabeculectomy function in 115 eyes,2 including 19 with hypotony (which we also defined as having an IOP ≤ 6 mm Hg) before cataract surgery. Antifibrosis agents had been used during trabeculectomy in most of these eyes, including mitomycin C in 13 eyes and 5-fluorouracil in 3 eyes. Thirteen eyes subsequently underwent phacoemulsification, and 6 had extracapsular cataract extraction. Our IOP findings after cataract extraction were similar to those of Doyle and Smith, with the mean IOP increasing significantly from 4.6 to 7.5 mm Hg (P = .002; paired 2-tailed t test), but 11 (58%) of 19 eyes did not have a final IOP higher than 6 mm Hg after a mean follow-up of 17 months. However, our treatment did not include the use of retained viscoelastic at case conclusion or routine minimization of postoperative anti-inflammatory medications. Two patients required short-term use of glaucoma medications, and 2 eyes underwent bleb needling (both within 1 month of cataract surgery). Visual acuity was improved by at least 2 lines in 18 (95%) of 19 patients, but 3 eyes required trabeculectomy revision for persistent hypotony. The methods of Doyle and Smith1 seem to result in better overall outcomes, although most of their patients had undergone previous interventions (eg, autologous blood injection with bandage contact lens placement in 6 eyes, and drainage of choroidal effusions with intraocular viscoelastic placement in 1 eye) that might have contributed to the postoperative course noted after phacoemulsification.

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