Cataract Surgery After Trabeculectomy: The Effect on Trabeculectomy Function | Cataract and Other Lens Disorders | JAMA Ophthalmology | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Rebolleda G, Muñoz-Negrete FJ. Phacoemulsification in eyes with functioning filtering blebs: a prospective study.  Ophthalmology. 2002;109(12):2248-225512466166PubMedGoogle ScholarCrossref
Manoj B, Chako D, Khan MY. Effect of extracapsular cataract extraction and phacoemulsification performed after trabeculectomy on intraocular pressure.  J Cataract Refract Surg. 2000;26(1):75-7810646150PubMedGoogle ScholarCrossref
Burratto L, Ferrari M. Extracapsular cataract surgery and intraocular lens implantation in glaucomatous eyes that had a filtering bleb operation.  J Cataract Refract Surg. 1990;16(3):315-3192355317PubMedGoogle Scholar
Dickens MA, Cashwell LF. Long-term effect of cataract extraction on the function of an established filtering bleb.  Ophthalmic Surg Lasers. 1996;27(1):9-148630762PubMedGoogle Scholar
Wygnanski-Jaffe T, Barak A, Melamed S, Glovinsky Y. Intraocular pressure increments after cataract extraction in glaucomatous eyes with functioning filtering blebs.  Ophthalmic Surg Lasers. 1997;28(8):657-6619268997PubMedGoogle Scholar
Seah SK, Jap A, Prata JA Jr,  et al.  Cataract surgery after trabeculectomy.  Ophthalmic Surg Lasers. 1996;27(7):587-5949240775PubMedGoogle Scholar
Casson R, Rahman R, Salmon JF. Phacoemulsification with intraocular lens implantation after trabeculectomy.  J Glaucoma. 2002;11(5):429-43312362084PubMedGoogle ScholarCrossref
Crichton AC, Kirker AW. Intraocular pressure and medication control after clear corneal phacoemulsification and AcrySof posterior chamber intraocular lens implantation in patients with filtering blebs.  J Glaucoma. 2001;10(1):38-4611219637PubMedGoogle ScholarCrossref
Derbolav A, Vass C, Menapace R, Schmetterer K, Wedrich A. Long-term effect of phacoemulsification on intraocular pressure after trabeculectomy.  J Cataract Refract Surg. 2002;28(3):425-43011973088PubMedGoogle ScholarCrossref
Mietz H, Andresen A, Welsandt G, Krieglstein GK. Effect of cataract surgery on intraocular pressure in eyes with previous trabeculectomy.  Graefes Arch Clin Exp Ophthalmol. 2001;239(10):763-76911760038PubMedGoogle ScholarCrossref
Friedman DS, Jampel HD, Lubomski LH,  et al.  Surgical strategies for coexisting glaucoma and cataract: an evidence-based update.  Ophthalmology. 2002;109(10):1902-191312359612PubMedGoogle ScholarCrossref
Wong TT, Khaw PT, Aung T,  et al.  The Singapore 5-Fluorouracil trabeculectomy study: effects on intraocular pressure control and disease progression at 3 years.  Ophthalmology. 2009;116(2):175-18419187822PubMedGoogle ScholarCrossref
Husain R, Clarke JC, Seah SK, Khaw PT. A review of trabeculectomy in East Asian people—the influence of race.  Eye (Lond). 2005;19(3):243-25215272288PubMedGoogle ScholarCrossref
Broadway DC, Chang LP. Trabeculectomy, risk factors for failure and the preoperative state of the conjunctiva.  J Glaucoma. 2001;10(3):237-24911442190PubMedGoogle ScholarCrossref
Chee SP, Ti SE, Sivakumar M, Tan DT. Postoperative inflammation: extracapsular cataract extraction versus phacoemulsification.  J Cataract Refract Surg. 1999;25(9):1280-128510476515PubMedGoogle ScholarCrossref
Siriwardena D, Kotecha A, Minassian D, Dart JK, Khaw PT. Anterior chamber flare after trabeculectomy and after phacoemulsification.  Br J Ophthalmol. 2000;84(9):1056-105710966966PubMedGoogle ScholarCrossref
Chen PP, Weaver YK, Budenz DL, Feuer WJ, Parrish RK II. Trabeculectomy function after cataract extraction.  Ophthalmology. 1998;105(10):1928-19359787366PubMedGoogle ScholarCrossref
Ehrnrooth P, Lehto I, Puska P, Laatikainen L. Phacoemulsification in trabeculectomized eyes.  Acta Ophthalmol Scand. 2005;83(5):561-56616187993PubMedGoogle ScholarCrossref
Wang X, Zhang H, Li S, Wang N. The effects of phacoemulsification on intraocular pressure and ultrasound biomicroscopic image of filtering bleb in eyes with cataract and functioning filtering blebs.  Eye (Lond). 2009;23(1):112-11617932506PubMedGoogle ScholarCrossref
Inal A, Bayraktar S, Inal B, Bayraktar Z, Yilmaz OF. Intraocular pressure control after clear corneal phacoemulsification in eyes with previous trabeculectomy: a controlled study.  Acta Ophthalmol Scand. 2005;83(5):554-56016187992PubMedGoogle ScholarCrossref
Chiseliţă D, Antohi I, Medvichi R,  et al.  The influence of cataract surgery on the efficacy of trabeculectomy in patients with open-angle glaucoma [in Romanian].  Oftalmologia. 2004;48(2):71-8015341104PubMedGoogle Scholar
Swamynathan K, Capistrano AP, Cantor LB, WuDunn D. Effect of temporal corneal phacoemulsification on intraocular pressure in eyes with prior trabeculectomy with an antimetabolite.  Ophthalmology. 2004;111(4):674-67815051197PubMedGoogle ScholarCrossref
Park HJ, Kwon YH, Weitzman M, Caprioli J. Temporal corneal phacoemulsification in patients with filtered glaucoma.  Arch Ophthalmol. 1997;115(11):1375-13809366666PubMedGoogle ScholarCrossref
The Fluorouracil Filtering Surgery Study Group.  Five-year follow-up of the Fluorouracil Filtering Surgery Study.  Am J Ophthalmol. 1996;121(4):349-3668604728PubMedGoogle Scholar
Clinical Sciences
Journal Club
Feb 2012

Cataract Surgery After Trabeculectomy: The Effect on Trabeculectomy Function

Journal Club PowerPoint Slide Download
Author Affiliations

Author Affiliations: Singapore National Eye Center and Singapore Eye Research Institute (Drs Husain, Liang, Oen, Seah, and Aung) and Yong Loo Lin School of Medicine, National University of Singapore (Drs Chew and Aung); and National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, England (Drs Husain, Foster, Gazzard, Bunce, and Khaw).

Arch Ophthalmol. 2012;130(2):165-170. doi:10.1001/archophthalmol.2011.329

Objective To determine whether the timing of cataract surgery after trabeculectomy has an effect on trabeculectomy function in terms of intraocular pressure control.

Methods 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.

Results 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.

Conclusions 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.