Performing cataract surgery in an eye with a preexisting trabeculectomy bleb raises unique challenges for the ophthalmic surgeon. Addressing the spectrum of bleb morphologies and the anatomic setting in which the cataract exists requires careful attention to detail and an array of surgical skills. Successful preoperative planning, intraoperative execution, and postoperative care can optimize the functional outcome of the bleb and the short- and long-term visual outcome for the patient.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
D’Ermo F, Bonomi L, Doro D. A critical analysis of the long-term results of trabeculectomy. Am J Ophthalmol 1979; 88:829–835.
Mills KB. Trabeculectomy: a retrospective long-term follow-up of 444 cases. Br J Ophthalmol 1981; 65:790–795.
Watson PG, Jakeman C, Oztur M, et al. The complications of trabeculectomy (a 20-year follow-up). Eye 1990;4:425–438.
Tornqvist G, Drolsum LK. Trabeculectomies: a longterm study. Acta Ophthalmol 1991; 69:450–454.
Popovic V, Sjostrand J. Long-term outcome following trabeculectomy: Retrospective analysis of intraocular pressure regulation and cataract formation. Acta Ophthalmol 1991;69:299–304.
Advanced Glaucoma Intervention Study (AGIS) Investigators. Advanced Glaucoma Intervention Study: 8. Risk of cataract formation after trabeculectomy. Arch Ophthalmol 2001;119: 1771–1779.
Molteno ACB, Bosma NJ, Kittelson JM. Otago glaucoma surgery outcome study: long-term results of trabeculectomy—1976 to 1995. Ophthalmology 1999;106:1742–1750.
Musch DC, Gillespie BW, Niziol LM, et al. Cataract extraction in the collaborative initial glaucoma treatment study: Incidence, risk factors, and the effect of cataract progression and extraction on clinical and quality-of-life outcomes for the collaborative initial glaucoma treatment study (CIGTS) group. Arch Ophthalmol 2006;124(12):1694–1700.
Shaffer RN, Rosenthal G. Comparison of cataract incidence in normal and glaucomatous population. Am J Ophthalmol 1970;69:368–371
Bernth-Petersen P, Bach E. Epidemiologic aspects of cataract surgery. III: frequencies of diabetes and glaucoma in a cataract population. Acta Ophthalmol 1983;61:406–416.
Lee AJ, Rochtchina E, Wang JJ, et al. Does smoking affect intraocular pressure? Findings from the Blue Mountains Eye Study. J Glaucoma 2003; 12:209–212.
van Heyningen R, Harding JJ. A case-control study of cataract in Oxfordshire some risk factors. Br J Ophthalmol 1988;72:804–808.
Harding JJ, Harding RS, Egerton M. Risk factors for cataract in Oxfordshire diabetes, peripheral neuropathy, myopia, glaucoma and diarrhoea. Acta Ophthalmol 1989;67:510–517.
Harding JJ, Egerton M, van Heyningen R, et al. Diabetes, glaucoma, sex, and cataract analysis of combined data from two case control studies. Br J Ophthalmol 1993;77:2–6.
Klein BE, Klein R, Moss SE. Incident cataract surgery the Beaver Dam Eye Study. Ophthalmology 1997;104:573–580.
Mitchell PG, Smith W, Chey T, et al. Open-angle glaucoma and diabetes: the Blue Mountains Eye Study, Australia. Ophthalmology 1997;104:712–718.
Cumming RG, Mitchell PG. Alcohol, smoking, and cataracts the Blue Mountains Eye Study. Arch Ophthalmol 1997;115:1296–1303.
Cumming RG, Mitchell PG, Leeder SR. Use of inhaled corticosteroids and the risk of cataracts. N Engl J Med 1997;337:8–14.
Mitchell PG, Hourihan F, Sandbach J, et al. The relationship between glaucoma and myopia the Blue Mountains Eye Study. Ophthalmology 1999; 106:2010–2015.
Mitchell PG, Cumming RG, Mackey DA. Inhaled corticosteroids, family history, and risk of glaucoma. Ophthalmology 1999;106:2301–2306.
Lim R, Mitchell PG, Cumming RG. Refractive associations with cataract the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci 1999;40:3021–3026.
Rowe NG, Mitchell PG, Cumming RG, et al. Diabetes, fasting blood glucose and age-related cataract the Blue Mountains Eye Study. Ophthalmic Epidemiol 2000;7:103–114.
Cumming RG, Mitchell PG, Lim R. Iris color and cataract the Blue Mountains Eye Study. Am J Ophthalmol 2000;130:237–238.
Weih LM, Mukesh BN, McCarty CA, et al. Association of demographic, familial, medical, and ocular factors with intraocular pressure. Arch Ophthalmol 2001;119:875–880.
Leske MC, Wu SY, Nemesure B, et al. Barbados Eye Studies Group, Risk factors for incident nuclear opacities. Ophthalmology 2002;109:1303–1308.
Klein BE, Klein R, Linton KL. Intraocular pressure in an American community. The Beaver Dam Eye Study. Invest Ophthalmol Vis Sci 1992;33:2224–2228.
Lichter PR, Musch DC, Gillespie BW, et al. Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery. Ophthalmology 2001;108:1943–1953.
Klein BE, Klein R, Lee KE, et al. Drug use and five-year incidence of age-related cataracts the Beaver Dam Eye Study. Ophthalmology 2001;108:1670–1674.
Chandrasekaran S, Cumming RG, Rochtchina E, et al. Associations between elevated intraocular pressure and glaucoma, use of glaucoma medications, and 5-year incident cataract: the Blue Mountains Eye Study. Ophthalmology 2006;113:417–424.
Hofeldt AJ, Weiss MJ. Illuminated near card assessment of potential acuity in eyes with cataract. Ophthalmology 1998;105:1531–1536.
Fletcher A, Vijaykumar V, Selvaraj S, et al. The Madurai Intraocular Lens Study III: Visual functioning and quality of life outcomes. Am J Ophthalmol 1998;125:26–35.
Wang JJ, Mitchell P, Simpson JM, et al. Visual impairment, age-related cataract, and mortality. Arch Ophthalmol 2001;119:1186–1190.
McGwin G, Owsley C, Gauthreaux S. The association between cataract and mortality among older adults. Ophthalmic Epidemiol 2003;10:107–119.
Knudtson MD, Klein BE, Klein R. Age-related eye disease, visual impairment, and survival: the Beaver Dam Eye Study. Arch Ophthalmol 2006;124:243–9.
Owsley C, McGwin G, Scilley K, et al. Impact of cataract surgery on health-related quality of life in nursing home residents. Br J Ophthalmol 2007;91:1359–1363.
Sach TH, Foss AJ, Gregson RM, et al. Falls and health status in elderly women following first eye cataract surgery: an economic evaluation conducted alongside a randomised controlled trial. Br J Ophthalmol 2007;91:1675–1679.
Hodge W, Horsley T, Albiani D, et al. The consequences of waiting for cataract surgery: a systematic review. CMAJ 2007;176:1285–1290.
Eakins KE. Prostaglandin and non-prostaglandin mediated breakdown of the blood-aqueous barrier. Exp Eye Res 1977;25:483–498.
Ernest PH, Tipperman R, Eagle R, et al. Is there a difference in incision healing based on location? J Cataract Refract Surg 1998;24:482– 486.
Chang DF, Campbell JR. Intraoperative floppy iris syndrome associated with tamsulosin (Flomax). J Cataract Refract Surg 2005;31:664–673.
Shugar JK. Intracameral epinephrine for prophylaxis of IFIS [letter]. J Cataract Refract Surg 2006;32:1074–1075.
Seah SK, Jap A, Prata JA, et al. Cataract surgery after trabeculectomy. Ophthalmic Surg Lasers 1996;27:587–594.
Chen PP, Weaver YK, Budenz DL, et al. Trabeculectomy function after cataract extraction. Ophthal 1998;105:1928–1935.
Park HJ, Kwon YH, Weitzman M, et al. Temporal corneal phacoemulsification in patients with filtered glaucoma. Arch Ophthalmol 1997;115:1375–1380.
Casson RJ, Riddell CE, Rahman R, et al. Long-term effect of cataract surgery on intraocular pressure after trabeculectomy: extracapsular extraction versus phacoemulsification. J Cataract Refract Surg 2002;28:2159–2164.
Rebolleda G, Muñoz-Negrete FJ. Phacoemulsification in eyes with functioning filtering blebs: a prospective study. Ophthalmology 2002;109:2248–2255.
Ozeveren F, Eltutar K. Therapeutic application of tissue plasminogen activator for fibrin reaction after cataract surgery. J Cataract Refract Surg 2004;30:1727–1731.
Wedrich A, Menapace R, Ries E, et al. Intracameral tissue plasminogen activator to treat severe fibrinous effusion after cataract surgery. J Cataract Refract Surg 1997; 23:873–877
Mackool RJ, Sirota M. Infusion misdirection syndrome. J Cataract Refract Surg 1993;19:671–672
Ruben ST, Tsai JC, Hitchings RA. Malignant glaucoma and its management. Br J Ophthalmol 1997;81:163–167.
Liyanage SE, Angunawela RI, Little BC. Conjunctival sweeping with a squint hook to reduce chemosis. J Cataract Refract Surg 2007;33:1691–1693.
Swan K. Reopening of nonfunctioning filters-simplified surgical techniques. Trans Am Acad Ophthalmol Otolaryngol 1975;79:342–348.
Elgohary MA, McCluskey P, Towler HM, et al. Outcome of phacoemulsification in patients with uveitis. Br J Ophthalmol 2007;91:916–21.
Vingolo EM, Grenga P, Iacobelli L, et al. Visual acuity and contrast sensitivity: AcrySof ReSTOR apodized diffractive versus AcrySof SA60AT monofocal intraocular lenses. J Cataract Refract Surg 2007;33:1244–1247.
MartÃnez PA, Gómez FP, España AA, et al. Visual function with bilateral implantation of monofocal and multifocal intraocular lenses: a prospective, randomized, controlled clinical trial. J Refract Surg 2008;24:257–264.
Cuthbertson FM, Dhingra S, Benjamin L. Objective and subjective outcomes in comparing three different aspheric intraocular lens implants with their spherical counterparts. Eye May 9, 2008 [Epub ahead of print].
Tzelikis PF, Akaishi L, Trindade FC, et al. Spherical aberration and contrast sensitivity in eyes implanted with aspheric and spherical intraocular lenses: a comparative study. Am J Ophthalmol. 2008;145:827–833.
Marshall J, Cionni RJ, Davison J, et al. Clinical results of the blue-light filtering AcrySof Natural foldable acrylic intraocular lens. J Cataract Refract Surg 2005;31:2319–2323.
Kara-Júnior N, Jardim JL, de Oliveira Leme E, et al. Effect of the AcrySof Natural intraocular lens on blue-yellow perimetry. J Cataract Refract Surg 2006;32:1328–1330.
Landers J, Tan TH, Yuen J, et al. Comparison of visual function following implantation of Acrysof Natural intraocular lenses with conventional intraocular lenses. Clin Experiment Ophthalmol 2007;35:152–15.
Burk SE, Da Mata AP, Snyder ME, et al. Visualizing vitreous using Kenalog suspension. J Cataract Refract Surg 2003;29:645–651.
Kasahara W, Sibayan SH, Montenegro MH et al. CE with internal bleb revision. Ophthal Surg Lasers 1996;27:361–366
Agrawal S, Agrawal J, Agrawal TP. Use of trypan blue to confirm the patency of filtering surgery. J Cataract Refract Surg 2005;31:235–237.
Dada T, Muralidhar R, Sethi HS. Staining of filtering bleb with trypan blue during phacoemulsification. Eye 2006;20:858–859.
Johnstone MA, Ziel CJ. Cataract surgery in the presence of a filtering bleb with postoperative 5-fluorouracil (5-FU). Invest Ophthalmol Vis Sci 1992;33:948.
Pasternack JJ, Wand M, Shields MB, Abraham D. Needle revision of failed filtering blebs using 5-Fluorouracil and a combined ab-externo and ab-interno approach. J Glaucoma 2005;14:47–51.
Shetty RK, Wartluft L, Moster MR. Slit-lamp needle revision of failed filtering blebs using high-dose mitomycin C. J Glaucoma 2005;4:52–56.
Gutiérrez-Ortiz C, Cabarga C, Teus MA. Prospective evaluation of preoperative factors associated with successful mitomycin C needling of failed filtration blebs. J Glaucoma 2006;15:98–102.
Sharmal TK, Arora S, Corridan PG. Phacoemulsification in patients with previous trabeculectomy: role of 5-fluorouracil. Eye 2007;21:780–783.
Starita RJ, Fellman RL, Spaeth GL, et al. Short- and long-term effects of postoperative corticosteroids on trabeculectomy. Ophthalmol 1985;92:938–946.
Araujo SV, Spaeth GL, Roth SM, et al. A ten-year follow-up on a prospective, randomized trial of postoperative corticosteroids after trabeculectomy. Ophthalmol 1995;102:1753–1759.
Hosseini H, Mehryar M, Farvardin M. Focus on triamcinolone acetonide as an adjunct to glaucoma filtration surgery. Medical Hypotheses 2007;68:401–403.
Kahook MY, Schuman JS, Noecker RJ. Needle Bleb Revision of Encapsulated Filtering Bleb With Bevacizumab. Ophthalmic Surg Lasers Imaging 2006;37:148–150.
Kitnarong N, Chindasub P, Metheetrairut A. Surgical outcome of intravitreal bevacizumab and filtration surgery in neovascular glaucoma. Adv Ther 2007;25:438–443.
Jonas JB, Spandau UH, Schlichtenbrede F. Intravitreal bevacizumab for filtering surgery. Ophthalmic Res 2007;39:121–122.
Shingleton BJ, Chang MA, Bellows AR, et al. Surgical goniosynechialysis for angle-closure glaucoma. Ophthalmology 1990;97:551–556.
Tanihara H, Nishiwaki K, Nagata M. Surgical results and complications of goniosynechialysis. Graefes Arch Clin Exp Ophthalmol 1992;230:309–313.
Teekhasaenee C, Ritch R. Combined phacoemulsification and goniosynechialysis for uncontrolled chronic angle-closure glaucoma after acute angle-closure glaucoma. Ophthalmology 1999;106:669–674
Campbell DG, Vela A. Modern goniosynechialysis for the treatment of synechial angle-closure glaucoma. Ophthalmology 1984;91:1052–1060
Chen T, Pongpun PR, Walton DS. Goniosynechiolysis. In: Chen T (ed) Surgical Techniques in Ophthalmology: Glaucoma Surgery. Saunders Elsevier, China. 2008.
van Haeringen NJ, van Sorge AA, Carballosa Coré-Bodelier VM. Constitutive cyclooxygenase-1 and induced cyclooxygenase-2 in isolated human iris inhibited by S(+) flurbiprofen. J Ocul Pharmacol Ther 2000;16:353–361.
Yamagami S, Araie M, Mori M, et al. Posterior chamber intraocular lens implantation in filtered or nonfiltered glaucoma eyes. Jpn J Ophthalmol 1994;38:71–79.
Dickens MA, Cashwell LF. Long-term effect of cataract extraction on the function of an established filtering bleb. Ophthalmic Surg Lasers 1996;27:9–14.
Chen PP, Weaver YK, Budenz DL, et al. Trabeculectomy function after cataract extraction. Ophthalmology 1998;105:1928–1935.
Manoj B, Chako D, Khan MY. Effect of extracapsular cataract extraction and phacoemulsification performed after trabeculectomy on intraocular pressure. J Cataract Refract Surg 2000;26:75–78.
Halikiopoulos D, Moster MR, Azuara-Blanco A, et al. The outcome of the functioning filter after subsequent cataract extraction. Ophthalmic Surg Lasers. 2001;32:108–117.
Shingleton BJ, O'Donoghue MW, Hall PE. Results of phacoemulsification in eyes with preexisting glaucoma filters. J Cataract Refract Surg 2003;29:1093–1096.
Swamynathan K, Capistrano AP, Cantor LB, et al. Effect of temporal corneal phacoemulsification on intraocular pressure in eyes with prior trabeculectomy with an antimetabolite. Ophthalmology 2004;111:674–678.
Ehrnrooth P, Lehto I, Puska P, et al. Phacoemulsification in trabeculectomized eyes. Acta Ophthalmol Scand 2005;83:561–566.
Inal A, Bayraktar S, Inal B, et al. Intraocular pressure control after clear corneal phacoemulsification in eyes with previous trabeculectomy: a controlled study. Acta Ophthalmol Scand 2005;83:554–560.
Crichton ACS, Kirker AW. Intraocular pressure and medication control after clear corneal phacoemulsification and Acry-Sof posterior chamber intraocular lens implantation in patientswith filtering blebs. J Glaucoma 2001;10:38–46.
Casson R, Rahman R, Salmon JF. Phacoemulsification with intraocular lens implantation after trabeculectomy. J Glaucoma 2002;11:429–433.
Derbolav A, Vass C, Menapace R, Schmetterer K, Wedrich A. Long-term effect of phacoemulsification on intraocular pressure after trabeculectomy. J Cataract Refract Surg 2002;28:425–430.
Ehrnrooth P, Lehto I, Puska P, Laatikainen L. Phacoemulsification in trabeculectomized eyes. Acta Ophthalmol Scand 2005;83:561–566.
Spaeth GL, Fellman RL. Cataract extraction in patients with glaucoma. In: Duane’s Ophthalmology, CD-ROM Edition. Clinical volume 6, chapter 16, 2001, Lippincott Williams & Wilkins.
Lama PJ, Fechtner RD. Antifibrotics and wound healing in glaucoma surgery. Surv Ophthalmol 2003;48:314–346.
Kolker AE. Visual prognosis in advanced glaucoma: a comparison of medical and surgical therapy for retention of vision in 101 eyes with advanced glaucoma. Trans Am Ophthalmol Soc 1977;75:539–555.
Aggarwal SP, Hendeles S. Risk of sudden visual loss following trabeculectomy in advanced primary open-angle glaucoma. Br J Ophthalmol 1986;70:97–99.
Levene RZ. Central visual field, visual acuity, and sudden visual loss after glaucoma surgery. Ophthalmic Surg 1992;23:388–394.
Law SK, Nguyen AM, Coleman AL, et al. Severe Loss of Central Vision in Patients Advanced Glaucoma Undergoing Trabeculectomy. Arch Ophthalmol 2007;125:1044–1050.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2009 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Mayer, H.R., Tsai, J.C. (2009). Cataract Surgery in the Presence of a Functioning Trabeculectomy Bleb. In: Johnson, S. (eds) Cataract Surgery in the Glaucoma Patient. Springer, New York, NY. https://doi.org/10.1007/978-0-387-09408-3_16
Download citation
DOI: https://doi.org/10.1007/978-0-387-09408-3_16
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-0-387-09407-6
Online ISBN: 978-0-387-09408-3
eBook Packages: MedicineMedicine (R0)