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Tip of the Month
Tip of the month - Cataract surgery after trabeculectomy increases the risk of bleb failure and this risk is increased if the time between trabeculectomy and cataract surgery is short
Cataract surgery after trabeculectomy increases the risk of bleb failure and this risk is increased if the time between trabeculectomy and cataract surgery is short

Publishing date: November 2013

Tip Editors: John Salmon and John ThygesenTip Editors: John Salmon and Gordana Sunaric M├ęgevand
Tip reviewer: Roger Hitchings


The Science behind the Tip

Trabeculectomy surgery is a recognised risk factor for the subsequent development of cataract. Phacoemulsification with intraocular lens implantation performed in the presence of a functioning trabeculectomy bleb has an adverse effect on IOP control and can lead to failure of the trabeculectomy bleb (1). Casson et al reported that 18% of patients who had a functioning bleb had commenced or were using additional glaucoma medication 2 years after cataract surgery (2).

The risk of trabeculectomy failure is increased if the time between trabeculectomy and cataract surgery is short; with an adjusted declining hazard ratio of 3.00 (95% CI 1.11 - 8.14) at 6 months and 1.32 (95% Cl 1.02 -1.69) at 2 years (3). The use of subconjunctival injections of 5-flurouracil after cataract surgery in these circumstances does not appear to reduce the risk of trabeculectomy failure (4).


Contributor: John Salmon, Oxford



References

1. Rebolleda G, Munoz-Negrete FJ.  Phacoemulsification in eyes with functioning blebs:  a prospective studly.  Ophthalmology 2002; 109:2248-2255.

2. Casson R, Rahman R, Salmon J.F.  Phacoemulsification with intraocular lens implantation after trabeculectomy.  J Glaucoma 2002; 11:429-433.

3. Husain R, Liang S, Foster PJ et al Cataract surgery after trabeculectomy:  the effect on trabeculectomy function.  Arch Ophthalmol 2012; 130: 165-170.

4. Shahid H, Salmon JF.  Use of 5-fluorouracil injections to reduce the risk of trabeculectomy bleb failure after cataract surgery.  J Ocular Pharm & Therapeutics 2010; 26:119-123.



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