Cataract or glaucoma surgery first?

This 5-year follow-up retrospective cohort study says that it doesn’t matter.

cortical cataract

This photo shows cortical cataract in an elderly patient. Cataracts and glaucoma are concomitantly seen in elderly patients and may both necessitate surgery. (Source via CC 4.0)

Cataract and glaucoma are the two most common causes of eye morbidities worldwide. They usually present together in the elderly population and require co-management. Cataract is resolved with surgical interventions, while glaucoma may be treated with either medical, lasesr, or surgical methods.

The most common surgical method to treat glaucoma is trabeculectomy. However, one-third of patients who have undergone this treatment will need cataract surgery within 2 years. There have also been reports of increased IOP in eyes that have undergone trabeculectomy and then cataract surgery, either due to the natural disease progression of glaucoma or to the inflammation present up to 6 months after cataract surgery.

In this retrospective cohort study, medical records of all trabeculectomy cases between 2007 and 2011 were gathered and reviewed up to a 5-year followup period. A total number of 194 eyes (194 patients) fit the inclusion criteria of the study. The patients were classified into 3 groups: (1) trabeculectomy alone (N=85); (2) trabeculectomy followed by cataract surgery within years (N=60); and (3) trabeculectomy done on a pseudophakic eye (N=49).

The results demonstrated that at 5 years, the average IOP (±SD) was 12.9 ± 3.5, 12.5 ± 4.8, and 12.7 ± 4.8 mmHg for groups 1, 2, and 3, respectively. No significant differences were observed among the groups with respect to extent of IOP reduction, number of medications, necessity of restarting medications, and reoperation rates. Almost 80% of patients either had retained or improved vision after trabeculectomy.

In conclusion, the sequence with which surgery is carried out did not appear to affect trabeculectomy function 5 years post-operatively.

Mathew, R., Parvizi, S. and Murdoch, I. (2018). Success of trabeculectomy surgery in relation to cataract surgery: 5-year outcomes. British Journal of Ophthalmology, 103(10), pp.1395-1400.

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