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Aims-To evaluate and compare prospectively the anterior chamber inflammatory response after phacoemulsification cataract surgery and after trabeculectomy with peripheral iridectomy. Methods-Anterior chamber inflammation was measured using the Kowa FM-500 laser flare meter in 131 patients undergoing trabeculectomy and 148 patients undergoing phacoemulsification cataract extraction with intraocular lens implantation. Flare was measured before surgery and on each postoperative visit up to 12 months. Results-Before surgery there was no significant diVerence in flare readings between the two groups. Following trabeculectomy flare returned to baseline levels 4 weeks after surgery, while following phacoemulsification cataract extraction it remained significantly higher at week 6 (p<0.006) and month 3 (p<0.05). Conclusions-Anterior chamber inflammation is more prolonged after cataract surgery than after trabeculectomy. This may have implications for the timing of trabeculectomy in relation to cataract surgery. (Br J Ophthalmol 2000;84:1056-1057 Quantification of changes in the bloodaqueous barrier helps our understanding of the eVects of anterior segment surgery and its complications. The purpose of this study was to evaluate and compare prospectively anterior chamber flare after phacoemulsification cataract extraction and after trabeculectomy with peripheral iridectomy. Materials and methodsOne hundred and thirty one consecutive patients undergoing routine trabeculectomy for primary open angle glaucoma were recruited. These patients had no history of pseudoexfoliation, uveitis, or previous ocular surgery. All trabeculectomies were performed as part of the ongoing (unmasked) Medical Research Council trial of intraoperative 5-fluorouracil. Approximately half received 5-fluorouracil (50 mg/ml) and half received normal saline placebo, both being applied for 5 minutes on a sponge during the operation. All cases had a limbal based conjunctival flap. Postoperative management included suture release, ocular massage, and bleb needling. Seven patients received subconjunctival 5-fluorouracil injections.One hundred and forty eight patients undergoing routine phacoemulsification surgery were also recruited. Their sole cause of visual loss was age related cataract and they had no other eye disease and no pseudoexfoliation. All phacoemulsification procedures were performed via a 3.2 mm clear corneal incision and completed with a 6 mm foldable silicon intraocular lens (Allergan S130NB). Viscoelastic (Provisc) was used during surgery and removed at the end of the procedure. A number of experienced surgeons performed all these operations at Moorfields Eye Hospital.In patients undergoing trabeculectomy topical steroids (dexamethasone 0.1% or prednisolone acetate 1%) were instilled 4-8 times daily for 6 weeks and then tapered oV. Topical dexamethasone 0.1% was instilled 4-6 times daily in the cataract patients for at least 4 weeks. Both groups of patients received topical chloramphenicol 0.5% four times daily for 1 month. Anterior...

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