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Abstract #18311 Published in IGR 3-3
The Advanced Glaucoma Intervention Study. 8. Risk of cataract formation after trabeculectomy
The AGIS InvestigatorsAnnals of ophthalmology (Skokie, Ill.) 2001; 119: 1771-1780
OBJECTIVES: To compare the risk of cataract formation in eyes with and without prior trabeculectomy, and to assess other risk factors for cataract METHODS: The Advanced Glaucoma Intervention Study (AGIS) has been following 789 eyes of 591 patients with medically uncontrolled open-angle glaucoma. From 1988-1992, these eyes were randomly assigned to either an argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy treatment sequence or to a trabeculectomy-ALT-trabeculectomy sequence. Cox regression analyses were used to assess risk factors for cataract formation during seven to 11 years of follow-up. MAIN OUTCOME MEASURES: Cataract, defined as either having had cataract surgery or confirmed severe lens opacity with a best-corrected Early Treatment Diabetic Retinopathy Study visual acuity score of less than 65 letters (worse than 20/50). RESULTS: Data are presented on the expected five-year cumulative probability of cataract formation in each randomized sequence by age and presence of diabetes at study entry. Overall, approximately half the eyes studied developed cataract. A first trabeculectomy, whether as the first or second AGIS intervention, increased the overall risk of cataract by 78% (risk ratio (RR) = 1.78; p < 0.001). Diabetes (RR = 1.47; p = 0.004) and age at study entry (RR = 1.07 per year of age; p < 0.001) were also risk factors for cataract. When postoperative complications of trabeculectomy were included in the analysis, the increased risk of cataract for eyes with a first trabeculectomy was reduced to 47% when complications did not occur (RR = 1.47; p = 0.003), and increased to 104% when complications did occur (RR = 2.04; p < 0.001). Several specific postoperative complications of trabeculectomy were associated with increased risk of cataract, particularly marked inflammation (RR = 3.29; p < 0.001) and flat anterior chamber (RR = 1.80; p = 0.004). Trabeculectomy with complications was also significantly associated with an increased risk of cataract in each of three lens regions: nuclear, cortical, and posterior subcapsular. CONCLUSIONS: In eyes of AGIS patients, after adjustment for age and diabetes, trabeculectomy increased the risk of cataract formation by 78%.
Dr D.E. Gaasterland, 4910 Massachusetts Avenue NW, Suite 210, Washington, DC 20016, USA. degaasterland@worldnet.att.net
Classification:
12.8.1 Without tube implant (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
