Which factors should be considered before deciding to combine cataract surgery with trabeculectomy?

Updated: May 18, 2020
  • Author: Maria Hannah Pia Uyloan de Guzman, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Answer

Answer

The decision to perform combined cataract surgery and trabeculectomy versus sequential surgery depends on many factors. These include the stage of the glaucoma, the visual impact of the cataract, the quality of IOP control, the impact of multiple trips to the operating room on the patient's general health and finances, and the target postoperative IOP. In addition, the following should be considered:

  • The technique of cataract extraction to combine with trabeculectomy should be the least invasive as this incites less inflammation. Thus, phacoemulsification is preferred over extracapsular cataract extraction. [30, 31, 32, 33]

  • There appears to be no difference in IOP control using a 1-site versus a 2-site phacotrabeculectomy. [34, 35]

  • Combined cataract surgery and trabeculectomy produces less IOP-lowering than trabeculectomy alone. [36, 37, 38, 39]

  • Cataract surgery performed in an eye with a functioning trabeculectomy can cause loss of IOP control or outright failure of the trabeculectomy. [40, 41, 42, 43] A longer interval between trabeculectomy and cataract surgery is associated with increased survival of the trabeculectomy. [44]

The success of trabeculectomy performed on an eye that has previously undergone uncomplicated cataract surgery does not appear to be diminished. [45]


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