• Cataract/Anterior Segment, Glaucoma

    This retrospective, case-control study found that phacoemulsification performed after trabeculectomy significantly increased rates of bleb failure at 12 months but not at 24 months.

    To the authors’ knowledge, this is the first study to compare the effect of phacoemulsification performed either before or after trabeculectomy on bleb function. Subjects included 18 patients who had phacoemulsification subsequent to trabeculectomy, and 30 patients who were pseudophakic for more than six months preceding their trabeculectomy.

    The authors found that phacoemulsification performed after trabeculectomy significantly increased rates of bleb failure at 12 months postop (P = 0.028) but not at 24 months (P = 0.522). There was no significant different between the groups in achievement of target IOP of ≤ 12 mm Hg, ≤15 mm Hg, or ≤18 mm Hg with or without additional topical treatment.

    They write that it remains important to differentiate any increased rate of trabeculectomy failure after cataract surgery from that which would occur owing to the natural history of bleb function, which is to fail over time. An interesting finding was that although there was no significant difference in the mean number of postoperative follow-up visits in the first 12 months post-second surgery, patients who underwent trab and then phaco could be expected to have two periods of intensive postoperative visits and 5-FU injections. Therefore, clinicians should remain mindful of how multiple visits and potential subsequent interventions may affect their patients’ quality of life.

    They conclude that larger prospective studies are needed to better understand the role of the natural lens and phacoemulsification in maintaining IOP control after filtration surgery and to assess patient-related outcomes. Ultimately, the clinician needs to manage glaucoma patients based upon an individualized target IOP, with appropriate timing of phacoemulsification and filtration surgery.