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Abstract #51932 Published in IGR 14-4
Incidence and management of cataract after glaucoma surgery
Patel HY; Danesh-Meyer HVCurrent Opinions in Ophthalmology 2013; 24: 15-20
PURPOSE OF REVIEW: This review summarizes the recent literature regarding the incidence and management of cataract following glaucoma surgery. RECENT FINDINGS: 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. SUMMARY: 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.
Department of Ophthalmology, University of Auckland, Auckland, New Zealand.
Full articleClassification:
9.4.4.2 Glaucomas associated with cataracts (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders > 9.4.4 Glaucomas associated with disorders of the lens)