Cataract Surgery in Patients with Functioning Glaucoma Filtration Surgery

The accelerated development of cataract is frequently seen in the years following glaucoma filtration surgery (1). Cataract surgery causes anterior chamber inflammation which has been shown to persist for up to six months after surgery (2). When performed after trabeculectomy, there is an increased risk of trabeculectomy failure associated with a shorter time interval between filtration surgery and subsequent cataract surgery (3). Although adjunctive treatments are often used to promote trabeculectomy survival when performing cataract surgery, there is no robust evidence currently available to support this (4).

The timing of cataract surgery in patients with a functioning drainage bleb should be carefully considered to mitigate this risk. These patients require closer post-operative monitoring and an increased duration of topical steroid therapy to achieve long-term trabeculectomy survival.

EGS Guidelines, 5th Edition, Pages 43,164, 169

Pearls Manager: Hari Jayaram

References:

1. AGIS (Advanced Glaucoma Intervention Study) Investigators. The Advanced Glaucoma Intervention Study: 8. Risk of cataract formation after trabeculectomy. Arch Ophthalmol. 2001 Dec;119(12):1771-9

2. Siriwardena D, Kotecha A, Minassian D, Dart JK, Khaw PT. Anterior chamber flare after trabeculectomy and after phacoemulsification. Br J Ophthalmol. 2000 Sep;84(9):1056-7.

3. Husain R, Liang S, Foster PJ, et al. Cataract Surgery After Trabeculectomy: The Effect on Trabeculectomy Function. Arch Ophthalmol. 2012;130(2):165–170

4. Ng WS, Jayaram H. Adjunctive modulation of wound healing during cataract surgery to promote survival of a previous trabeculectomy. Cochrane Database Syst Rev. 2021 Aug 6;8:CD013664