Trabeculectomy function after cataract extraction

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Cataract Surgery

Background:

• Trabeculectomy is a common glaucoma surgery to lower intraocular pressure (IOP).
• Cataract extraction (CE) is often performed after trabeculectomy in patients with coexisting glaucoma and cataracts.
• The impact of CE on IOP control after trabeculectomy requires further investigation.

Purpose of the Study:

• To evaluate the effect of cataract extraction (CE) on intraocular pressure (IOP) control in patients who have previously undergone trabeculectomy.
• To identify factors associated with loss of IOP control after CE in this patient population.

Main Methods:

• Retrospective case series of 115 patients undergoing extracapsular or phacoemulsification CE after trabeculectomy.
• Analysis of preoperative, intraoperative, and postoperative factors.
• Kaplan-Meier survival analysis and Cox regression for identifying predictors of IOP control loss.

Main Results:

• 30.4% of eyes required additional medication or bleb needling for IOP control.
• 9.6% of eyes eventually required further glaucoma surgery.
• Younger age (≤50 years), higher preoperative IOP (>10 mmHg), intraoperative iris manipulation, and early postoperative peak IOP (>25 mmHg) were associated with worse IOP control.
• Most bleb failures occurred within 3 months post-CE.
• Resolution of preoperative hypotony was unpredictable.

Conclusions:

• Cataract extraction after trabeculectomy is associated with a risk of worsened IOP control.
• Key risk factors include patient age, preoperative IOP, intraoperative iris manipulation, and early postoperative IOP.
• Close monitoring is essential after CE in patients with a history of trabeculectomy, as bleb failures often occur early.