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5-year study shows cataract surgery has no impact on trabeculectomy outcomes
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Sequencing and timing of cataract surgery does not affect the results of trabeculectomy at 5 years, according to a study.
The authors noted that one-third of the patients undergoing trabeculectomy need cataract surgery to be performed within 2 years, and two-thirds require it within 8 years.
They also pointed out that there is still debate on whether cataract surgery should be performed before or after the filtration procedure, as well as on the interval that should run between the two procedures.
In the study, the medical records of 194 patients who had undergone trabeculectomy and had a minimum follow-up of 5 years were reviewed. The results of a first group who had trabeculectomy alone were compared with those of a second and third group who had trabeculectomy after cataract surgery and cataract surgery within 2 years of trabeculectomy. This comparison was aimed at evaluating the effect of cataract surgery on the natural history of trabeculectomy.
There was no significant difference between the groups in terms of IOP reduction, number of medications, restarting medications over time and reoperation rates at 5 years.
“Our findings suggest that the order of trabeculectomy and cataract surgery makes no major difference to success,” the authors wrote.
Interestingly, subanalysis showed a higher failure rate in male than female patients, maybe due to lesser compliance, according to the authors.
A secondary outcome measure of visual acuity changes at 5 years showed that vision was retained or improved in 80% of patients. – by Michela Cimberle
Disclosure: The authors reported no relevant financial disclosures.
Perspective
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Lisa M. Young, OD, FAAO
Creating the perfect bleb is an art. It takes months to create this masterpiece, requiring not only surgical precision but the patience to perfectly titrate the healing process for an optimal outcome. The overall success of a trabeculectomy requires just the right amount of scarring; too little results in hypotony, too much and the bleb inevitably fails.
Addressing cataracts in the presence of glaucoma can make it even trickier, as additional inflammation can potentially affect bleb function. For this reason, many surgeons debate whether cataract surgery should be performed before or after filtering surgery. Through a retrospective analysis, Mathew and colleagues found that the order of cataract surgery and trabeculectomy doesn’t impact the overall success rate of filtering surgery after 5 years.
While this information won’t have a significant impact on the way that I practice, it does give me reassurance that cataracts can wait to be addressed as visually indicated, regardless of the time frame for filtering surgery. One caveat: Discuss these results with your glaucoma specialist, because when it comes to surgery, individual results may vary.
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