Incidence and management of cataract after glaucoma surgery

PURPOSE OF REVIEWThis review summarizes the recent literature regarding the incidence and management of cataract following glaucoma surgery. RECENT FINDINGSHalf of the total number of phakic patients that have either trabeculectomy or tube shunt surgery will go on to develop visually significant cataract within 5 years. Phacoemulsification following trabeculectomy is significantly associated with bleb failure and loss of intraocular pressure (IOP) control. Recent studies suggest that the risk of bleb failure increases, the earlier cataract surgery is performed, and recommend a delay of at least 1–2 years after trabeculectomy to enable the bleb to stabilize. Bleb failure occurs because of scarring secondary to postoperative inflammation. Evidence suggests that intraoperative subconjunctival 5-fluorouracil (5-FU) may be protective, and repeated postoperative 5-FU injections may have a role in high-risk individuals along with aggressive anti-inflammatory treatment. Phacoemulsification following tube shunt surgery improves vision and does not affect IOP control. Novel glaucoma procedures are emerging, but they are often combined with cataract surgery, and/or clinical studies are at an early stage. SUMMARYThe development of visually significant cataract is common after glaucoma surgery. Subsequent cataract surgery can affect IOP control following trabeculectomy but not after tube shunt surgery. Measures to minimize the risk of bleb failure and loss of IOP control following trabeculectomy are critical in the management approach to patients who have had trabeculectomy.