Cataract Extraction and Lens Implantation in Eyes with Pre-Existing Filtering Blebs

23-gauge transconjunctival vitrectomy in eyes with pre-existing functioning filtering blebs

“…In 1976, Kolker and Heathering reported a 50 % loss of filtering bleb in intracapsular cataract extraction carried out after trabeculectomy [ 9 ]. However, with development of phacoemulsification, Alpar reported that loss of filtering bleb occurred in only 1 of 7 eyes with phacoemulsification after trabeculectomy [ 3 ]. Likewise, when vitrectomy is needed in eyes that receive prior trabeculectomy, it would be more advantageous to use transconjunctival sutureless microincisional PPV than the 20G conventional PPV.…”

“…Occasionally, patients with functioning filtering blebs may require pars plana vitrectomy (PPV) for various vitreoretinal disease. Although several studies have evaluated the effect of cataract extraction on functioning filtering bleb trabeculectomy outcome, only a few have focused on the impact of PPV on filtering bleb function [ 3 ]. Thompson et al reported that it is difficult to maintain bleb function when 20-gauge (20G) conventional vitrectomy is performed after trabeculectomy [ 4 ].…”

Evaluation of Phacotrabeculectomy versus Trabeculectomy Alone

“…It is debated whether in eyes with coexisting cataract and glaucoma the cataract or the glaucoma should be operated on first, or whether both procedures should be performed in one session [1]. Treating patients with progressive cataract and advanced glaucoma with trabeculectomy followed at a later point by phacoemulsification and intraocular lens implantation is probably favored by those who maintain that trabeculectomy, as the first step in this two-step approach, has a greater effect on intraocular pressure (IOP) than the combined procedure, and that the cataract surgery has no deleterious effect on the active bleb [2, 3, 4, 5, 6, 7]. The combined procedure offers other specific advantages over two separate operations: no bleb failure and no pressure spikes resulting from secondary cataract surgery, immediate improvement of visual acuity, and performance of only one surgery [1, 8, 9, 10, 11, 12, 13].…”

Glaucoma as a problem in intraocular lens implantation

“…In simple cataract surgery, preceded by any type or filtration operation for glaucoma, bleb closure occurs in about 50% of cases (Nordlohne, 1975;Alpar, 1979) and confronts us with the problems cited before. Moreover, after insertion of an IOL in an eye with a postoperative patent bleb, one risks a contact between lens and cornea endothelium due to loss or shallowness of the anterior chamber.…”

“…The iris has to be sutured to prevent displacement, or even dislocation of an iris-fixated lens (Nordlohne, 1975;Alpar, 1979), In many instances one is forced to make a radial iridectomy.…”