Association of Ultra-Short-Term Intraocular Pressure Fluctuation With Disease Progression in Primary Angle Closure Glaucoma: The CUPAL Study.

PRCIS: This study demonstrated significant differences in ultra-short-term IOP fluctuations, measured by a contact lens sensor between progressive and stable PACG eyes, during the first one hour after falling asleep. PURPOSE: To identify the most sensitive period for detecting significant ultra-short-term intraocular pressure (IOP) fluctuation associated with disease progression in primary angle closure glaucoma (PACG). MATERIALS AND METHODS: PACG eyes, which had been followed up for over 2 years under the CUHK PACG Longitudinal (CUPAL) Study, were recruited. Eyes with or without functional or structural glaucomatous progression were classified into 'progressive' or 'stable' groups on the basis of serial visual field and retinal nerve fiber layer (RNFL) thickness documentations, respectively. Ultra-short-term IOP fluctuations were recorded by Sensimed Triggerfish sensors (Sensimed AG, Lausanne, Switzerland) with 288 readings over 30 seconds, at 5-minute intervals, over a 24-hour period. In each of 7 activity-related 1-hour periods during the examining day, the mean value of the amplitude-frequency profiles of the signal fluctuations in twelve 30-second intervals was calculated by semivariogram/semi-variance. The 'progressive' and 'stable' groups were compared by permutation tests on functional t-statistics. RESULTS: Among the 25 recruited PACG eyes, 16 eyes were classified as RNFL 'progressive' group (the mean rate of change in global RNFL thickness: -0.199 ±0.128 µm/mo). Higher signal fluctuations, in terms of amplitude-frequency, were found during the first 1-hour period of sleeping in the RNFL 'progressive' group compared with the RNFL 'stable' group ( P =0.028). CONCLUSIONS: Between RNFL 'progressive' and 'stable' PACG eyes, significant differences in ultra-short-term IOP fluctuation at the 1-hour period after falling asleep were identified. The first hour of sleeping may be the most sensitive period for detecting significant ultra-short-term IOP fluctuation in PACG eyes.

Combined Phacoemulsification-Endoscopic Cyclophotocoagulation versus Phacoemulsification Alone in Primary Angle-Closure Glaucoma: A Pilot Randomized Controlled Trial.

PURPOSE: To compare combined phacoemulsification plus endoscopic cyclophotocoagulation (ECP) versus phacoemulsification alone in primary angle-closure glaucoma (PACG) with coexisting cataract. DESIGN: Prospective randomized controlled clinical trial-a pilot study. PARTICIPANTS: Forty-eight PACG eyes of 48 patients with coexisting cataract. INTERVENTION: Recruited patients were randomized into undergoing phacoemulsification plus ECP or phacoemulsification alone. After surgery, patients were followed up every 3 months for 2 years. MAIN OUTCOME MEASURES: Intraocular pressure (IOP) and requirement for topical glaucoma drugs. RESULTS: Twenty-seven PACG eyes were randomized to receive combined phacoemulsification plus ECP, and 21 PACG eyes underwent phacoemulsification alone. There was no statistically significant difference in mean preoperative IOP between combined phacoemulsification plus ECP and phacoemulsification groups (20.0 mmHg vs. 20.7 mmHg; P = 0.71). Phacoemulsification plus ECP resulted in lower mean postoperative IOP than phacoemulsification alone at all follow-up visits, but the differences only reached statistical significance at 1 month (P = 0.01), 12 months (P = 0.01), and 24 months (P = 0.04) postoperatively. There was no statistically significant difference in mean preoperative number of topical glaucoma drugs between combined phacoemulsification plus ECP and phacoemulsification groups (3.3 vs 3.1, P = 0.71). Combined phacoemulsification plus ECP resulted in lower glaucoma drug requirement than phacoemulsification alone at all follow-up visits, but the differences did not reach statistical significance at any time points postoperatively (P ≥ 0.05). Both groups were comparable in visual improvement, complication rate, need for additional surgical intervention, and visual field changes. CONCLUSIONS: Combined phacoemulsification plus ECP is noninferior to phacoemulsification alone in controlling IOP in PACG eyes with cataract. Combined phacoemulsification plus ECP resulted in lower mean IOP and glaucoma drug requirement than phacoemulsification alone at all follow-up visits in this pilot study, but the differences did not reach statistical significance at the majority of time points. A large-scale randomized controlled trial is in progress to evaluate these differences.

Ten-Year Clinical Outcomes of Acute Primary Angle Closure Randomized to Receive Early Phacoemulsification Versus Laser Peripheral Iridotomy.

PURPOSE: To compare the 10-year clinical outcomes of eyes with acute primary angle closure (APAC) randomized to receive either early phacoemulsification or laser peripheral iridotomy (LPI). METHODS: Sixty-two APAC patients, who underwent either early phacoemulsification (phaco group) or laser peripheral iridotomy (LPI group) in a previous randomized controlled trial, were invited for assessment 10 years after the interventions. The results of the 2 groups were compared. RESULTS: Forty of 62 patients (64.5%; 19 in phaco group and 21 from LPI group) were examined. None of them underwent additional glaucoma procedure but 15 (71.4%) patients in the LPI group received lens extraction before this assessment. The mean follow-up duration was 10.7±0.7 years. The phaco group used less medication (0.16±0.37 vs. 0.76±1.09 bottle per eye, P=0.028), had less extensive anterior synechiae (120.0±116.12 vs. 244.3±139.8 degree, P=0.010), and greater mean Shaffer gonioscopy grading (1.79±0.84 vs. 1.40±0.87; P=0.021) than the LPI group. Five eyes had persistent intraocular pressure elevation of >21 mm Hg in 2 consecutive visits and 4 eyes had blindness (best-corrected visual acuity worse than 6/60 and/or central visual field of <20 degree) in the LPI group, compared with none in the phaco group (P=0.022 and 0.045, respectively). There was no significant difference in the mean intraocular pressure, best-corrected visual acuity, and the number of eyes with visual field progression. CONCLUSION: At 10 years, APAC eyes that underwent early phacoemulsification required less medication, less peripheral anterior synechiae, lower incidence of intraocular pressure elevation and a lower incidence of blindness compared with APAC eyes that underwent initial LPI.

Case report - Acute Corneal Subepithelial Hydrops (ACSH) during Micropulse Transscleral Cyclophotocoagulation (MPTSC).

BACKGROUND: To present an unusual intra-operative complication of micropulse transscleral cyclophotocoagulation (MPTSC). CASE PRESENTATION: A 72-year old Chinese gentleman, who had primary angle closure glaucoma and had received bilateral laser iridotomy, presented with progressive left eye blurred vision (visual acuity of 20/40 OD and 20/200 OS). Examination reviewed left eye central retinal venous occlusion. The intraocular pressure (IOP) was 19 mmHg OS and was on maximally tolerated topical medications. Four weeks later, the left eye was complication by neovascular glaucoma; the IOP was raised to 26 mmHg despite additional oral acetazolamide and remained elevated after pan-retinal photocoagulation as well as cataract extraction by phacoemulsification. MPTSC was performed 8 days after the phacoemulsification. During the procedure, a sudden protrusion was formed on the corneal surface. On-table examination with operating microscope and portable slit-lamp reviewed an intact corneal epithelium with a globular-shaped collection of fluid at the subepithelial layer - acute corneal subepithelial hydrops (ACSH). The anterior chamber was formed and the globe was intact. After approximately 10-15 minutes, the swelling spontaneously ruptured and became a corneal epithelial defect. The defect healed on the tenth day after the event with conservative management. There was no irreversible corneal damage and the patient subsequently underwent a successful second MPTSC of the left eye because of poorly controlled IOP. CONCLUSION: ACSH is a possible intra-operative complication of MPTSC. We have proposed the possible mechanisms of ACSH. It is best to exercise caution when using MPTSC shortly after any incisional intraocular surgery.

The Tenons' Layer Reposition Approach of Trabeculectomy: A Longitudinal Case Series of a Mixed Group of Glaucoma Patients.

SYNOPSIS: This 1-year prospective study demonstrated that the Tenon's layer reposition approach of trabeculectomy could achieve zero leakage rate, minimal rate of transient hypotony without compromising the surgical outcome. PURPOSE: The purpose of this study was to investigate the effectiveness and safety of a Tenon's layer reposition approach of trabeculectomy. METHODS: A prospective, noncomparative case series of 30 eyes of 30 Chinese patients with mixed types of glaucoma who underwent fornix-based trabeculectomy combined with intraoperative mitomycin C application. During the conjunctival flap closure, the Tenons' layer was identified, separated, and anchored on to the sclera surface with 8/0 vicryl, followed by conjunctival closure with 10/0 nylon as a separate layer. All patients were followed up for 1 year. Assessment including intraocular pressure (IOP), vertical cup-disc ratio measurement, best-corrected visual acuity, and visual field examination were performed before and after the operation. Qualified and complete success was defined as IOP of ≤21 mm Hg in 2 consecutive visits with or without medication, respectively. Outcomes were evaluated using scattered plot and Kaplan-Meier survival curve. RESULTS: Twenty-one eyes (70%) and 28 eyes (93.3%) achieved complete and partial success at 1 year, respectively. There was a significant reduction of IOP (28.5±9.6 to 15.5±2.6 mm Hg, P<0.001) and medication use (4.4±0.9 to 0.8±1.2 bottles/eye, P<0.001). There were no significant changes in best-corrected visual acuity, vertical cup-disc ratio, and visual field indices. No wound leak was identified throughout the study. The procedure did not induce significant astigmatic change. Other postoperative complications, including 2 eyes (6.7%) with transient hypotony and 1 eye (3.3%) required cataract surgery, were of relatively low rate. CONCLUSION: The Tenon's layer reposition approach of performing trabeculectomy is a safe and efficacious procedure for Chinese subjects with different types of glaucoma.

Factors Associated With Long-term Intraocular Pressure Fluctuation in Primary Angle Closure Disease: The CUHK PACG Longitudinal (CUPAL) Study.

PURPOSE: To determine the demographic, ocular, and systemic factors associated with long-term intraocular pressure (IOP) fluctuation in primary angle closure disease (PACD). METHODS: This prospective cohort study included 422 PACD eyes from 269 Chinese patients, including 274 primary angle closure glaucoma (PACG) eyes and 152 primary angle closure/primary angle closure suspect (PAC/PACS) eyes. Long-term IOP fluctuation defined as the SD of all IOP measurements over 2 years (at least 5 measurements in total). Chinese patients with PACD were recruited and followed up 3 monthly. Eyes with IOP-lowering surgery or lens extraction performed within the 2-year study period were excluded. Patient demographics, received treatments, ocular biometry, retinal nerve fiber layer thickness, and systemic factors (eg, hypertension, smoking) were evaluated. Generalized estimating equations adjusting for inter-eye correlation were used to determine the associations. RESULTS: Eyes with PACG had significantly higher IOP fluctuation than PAC/PACS (2.4±1.2 versus 2.1±0.9 mm Hg; P=0.04). In the multivariate analysis with PACG eyes, higher baseline IOP (P<0.001), greater number of IOP-lowering medications (P<0.001), previous trabeculectomy (P=0.002), and current smoking (P=0.03) were significantly associated with larger IOP fluctuation, whereas diabetes mellitus was associated with lower IOP fluctuation (P=0.03). Among PAC/PACS eyes, younger age group (P<0.001), male sex (P=0.002), and higher baseline IOP (P<0.001) were significantly associated with larger IOP fluctuation. CONCLUSIONS: PACG eyes have greater IOP fluctuation than PAC/PACS eyes. Certain demographic, ocular, and systemic factors are associated with IOP fluctuation in PACD eyes.

Comparison of self-measured diurnal intraocular pressure profiles using rebound tonometry between primary angle closure glaucoma and primary open angle glaucoma patients.

PURPOSE: To document the diurnal intraocular pressure (IOP) profile with rebound tonometry performed by primary glaucoma patients in non-clinic environment. PATIENTS AND METHODS: Fifty-three medically-treated eyes of 31 primary angle closure glaucoma (PACG) and 22 primary open angle glaucoma (POAG) patients with no previous eye surgery were recruited. Diurnal IOP was measured 5 times per day at four-hourly intervals from 08:00 to 24:00 for 1 week in patients' study eye using rebound tonometry in a non-clinic environment. The diurnal IOP profiles were compared between PACG and POAG eyes. RESULTS: For both PACG and POAG eyes, mean patient-measured IOP was highest in the morning, gradually decreased over the course of a day, and was lowest by midnight (p < 0.001). The diurnal IOP fluctuation ± 1 standard deviation (SD), as documented by SD in daily IOP values, was lower in PACG group (1.6 ± 1.1 mmHg) than in POAG group (2.0 ± 1.2 mmHg; p = 0.049). The mean trough IOP ± 1 SD was higher in PACG group (12.9 ± 2.8 mmHg), compared to POAG group (11.5 ± 3.8 mmHg; p = 0.041). The mean IOP level at midnight ± 1 SD in PACG group (14.0 ± 3.2 mmHg) was higher than that in POAG group (12.1 ± 3.7 mmHg; p = 0.013). CONCLUSIONS: IOP in primary glaucoma patients was highest in the morning, and decreased over the course of a day in non-clinic environment. Treated diurnal IOP fluctuation seemed to be greater in POAG than PACG eyes.

Agreement of patient-measured intraocular pressure using rebound tonometry with Goldmann applanation tonometry (GAT) in glaucoma patients.

This study aims to determine the agreement of patient-measured intraocular pressure (IOP) using rebound tonometry with ophthalmologist-measured IOP using Goldmann applanation tonometry (GAT). Fifty-three glaucoma patients used rebound tonometry (Icare ONE, Icare Finland Oy., Finland) to measure their own IOP in ambient environments for 1 week, 5 times per day. Clinic IOP measurements were performed by ophthalmologists using GAT and by patients using rebound tonometry on examination days 1, 4 and 7 of the same week. The agreement between the two tonometries was evaluated by modified Bland-Altman plots and intra-class correlation coefficient (ICC) was determined. Differences in ICCs of them among the three examination days were evaluated by bootstrap resampling analysis. Respective within-measurement ICC of GAT and rebound tonometry were 0.98 and 0.94 on Day 1, 0.98 and 0.93 on Day 4, and 0.96 and 0.92 on Day 7. In a modified Bland-Altman plot, the mean difference ±1 standard deviation (SD) between the two tonometries was 0.15 ± 0.65 mmHg (p = 0.682). Between-measurement ICC were 0.66, 0.76 and 0.73 on the 3 examination days. There was no significant difference among ICCs. In conclusion, patient-measured IOP using rebound tonometry and ophthalmologist-measured IOP using GAT demonstrate good agreement.

Managing Primary Angle Closure Glaucoma - The Role of Lens Extraction in this Era.

Trabeculectomy has been the gold standard in reducing intraocular pressure (IOP) in glaucoma patients, no matter it is angle closure or open angle glaucoma. However in primary angle closure glaucoma, no matter the lens is cataractous or not, it is likely to be pathological, this thicker than usual lens, with or without a more anterior position, is often regarded as a strong contributing factor to angle closure. Lens extraction, no matter it is cataractous or clear, can theoretically eliminate this anatomical predisposing factor of angle closure, and thus IOP can be reduced. Based on recent results of a number of clinical trials, lens extraction alone or in combination with other IOP-lowering surgeries, may therefore play a more important role in the treating primary angle closure glaucoma. In cases when greater IOP-lowering effect is needed or if drug dependency has to be minimized, combined procedures, such as phacotrabeculectomy, can be considered, but the surgical risk can be higher than lens extraction alone.

In vitro characteristics of Tenon's fibroblast lines derived from pediatric and adult eyes do not fully explain pediatric glaucoma surgery failure: a preliminary report.

PURPOSE: To compare the in vitro characteristics of Tenon's capsule fibroblasts from children and adults that may be relevant to filtration surgery success. METHODS: Fibroblast cell lines derived from 5 young (median patient age, 2.4 years) and 7 old (median patient age, 71 years) discarded Tenon's capsule surgical specimens were used at early passage (P2-P3). Fibroblasts were plated at "high" (10(4)cells/cm(2)) or "low" density (10(3)cells/cm(2)) and harvested at days 0-14, for growth curve and doubling time comparisons. Migration was measured using a wound model (confluent monolayers ± 5-fluorouracil [5-FU] over 1-96 hours). Collagen synthesis was measured as secreted hydroxyproline/24 hours from confluent monolayers. RESULTS: At low density, "young" fibroblasts achieved higher cell numbers at confluence (day 14) compared with "old": 158 ± 35 versus 105 ± 12 × 10(3)cells/cm(2) (P = 0.0034). Mean doubling time for young versus old was similar at low density plating: 20.95 ± 1.55 versus 22.37 ± 2.09 hours (P = 0.26). It was shorter, however, for young versus old at high-density plating: 42.11 ± 6.01 versus 54.26 ± 4.24 hours (P = 0.0051). Wound closure rates were similar for young versus old cells (4 lines for each group) with and without 5-FU. Collagen synthesis was similar for young and old (4 lines for each group). CONCLUSIONS: Although young fibroblasts reached higher density than old at confluence and had shorter doubling times at high-density plating, wound closure/migration and collagen synthesis rates were similar. Despite the preliminary nature of this study (few specimens, limited cell features explored), factors besides those intrinsic to the fibroblasts themselves likely mediate the more rapid healing/scarring after glaucoma filtration surgery in children.

Circadian Intraocular Pressure Fluctuation and Disease Progression in Primary Angle Closure Glaucoma.

PURPOSE: To document the continuous circadian intraocular pressure (IOP) fluctuation using a contact lens sensor during normal daily activities, and to study the relationship between IOP fluctuation and disease progression in primary angle closure glaucoma (PACG) eyes. METHODS: Circadian IOP fluctuations were recorded by Sensimed Triggerfish sensors in 25 PACG eyes. The sensor output signals were smoothed using B-spline smoothing transform and described by functional data analysis. Glaucoma progression was documented with serial changes in mean deviation (MD) and visual field index (VFI) in Humphrey automated perimetry and retinal nerve fiber layer (RNFL) thickness. The signals were compared between the progressive and stable groups by permutation tests on functional t-statistic. RESULTS: Statistically significant differences were found from 2200 to 2300 and from 0700 to 0800 in gradients of the IOP fluctuation curve, as well as from 2300 to 2400 and 0800 to 0900 in curvatures of the IOP fluctuation curves, between the progressive MD and stable MD groups (P < 0.05). Significant gradient differences were also found from 1500 to 1600 and 0600 to 0800 between the progressive VFI and stable VFI groups, and from 2400 to 0100 and 0200 to 0300 between the progressive RNFL and stable RNFL groups (P < 0.05). CONCLUSIONS: Significant differences in circadian IOP fluctuation between progressive and stable PACG eyes were identified. Large IOP fluctuations may be associated with disease progression in PACG eyes.

Ultrasound evaluation of glaucoma drainage devices in children.

This study evaluated B-scan ultrasound as a technique for assessing glaucoma drainage device (GDD) patency/function in refractory pediatric glaucoma. We retrospectively evaluated 70 eyes of 52 patients after Ahmed (n = 40 eyes), Baerveldt (n = 27 eyes) and Molteno (n = 5 eyes) GDD implantation; 2 eyes each had 2 GDDs. Median age was 6.5 years. Glaucoma diagnoses included primary congenital glaucoma (n = 19) and secondary glaucoma associated with aphakia (n = 16), aniridia (n = 5), Peters anomaly (n = 3), uveitis (n = 2), and other conditions (n = 7). B-scan ultrasound evaluation proved helpful to clinical assessment when the GDD tube was not seen because of opaque corneas (n = 20 eyes), the bleb was not visualized (n = 21 eyes), or IOP was elevated (n = 28 eyes). Ultrasound findings suggesting a nonpatent or malfunctioning GDD were further confirmed by subsequent intraoperative bleb needling (n = 2 eyes) and GDD revision (n = 7 eyes). B-scan ultrasound evaluation can serve as a useful adjunct in evaluating GDD patency/function in selected eyes with refractory pediatric glaucoma and may aid in clinical management.

Anatomical effects of clear lens extraction by phacoemulsification versus trabeculectomy on anterior chamber drainage angle in primary angle-closure glaucoma (PACG) patients.

PURPOSE: To document the anatomical effects of clear lens extraction by phacoemulsification versus trabeculectomy on anterior chamber angle in patients with primary angle-closure glaucoma (PACG). METHODS: Gonioscopy and ultrasound biomicroscopy (UBM) were performed pre-operatively, and at 1 year after clear lens extraction or trabeculectomy in PACG eyes. RESULTS: Fifty PACG eyes of 50 patients were included. Twenty-six eyes had clear lens extraction by phacoemulsification, while 24 eyes underwent trabeculectomy. The mean extent of synechial angle closure was significantly reduced from 272.3° ± 57.3° to 253.3° ± 70.5° (p = 0.007) by phacoemulsification, but it was only reduced from 285.0° ± 64.6° to 283.1° ± 55.5° (p = 0.32) by trabeculectomy. The mean angle-opening distance at 500 microns from sclera spur (AOD500) measured by UBM was significantly increased from 220.3 ± 93.8 microns to 388.9 ± 134.1 microns (p < 0.001) by clear lens extraction, but decreased from 220.9 ± 79.8 microns to 214.5 ± 70.2 microns (p = 0.11) by trabeculectomy. The mean anterior chamber depth (ACD) measured by UBM was significantly increased from 1,983.8 ± 176.8 microns to 3335.0 ± 174.2 microns (p < 0.001) by clear lens extraction, but decreased from 2,000.2 ± 214.5 microns to 1975.8 ± 218.2 microns (p = 0.001) by trabeculectomy. CONCLUSION: Compared to trabeculectomy, clear lens extraction resulted in a significant reduction in synechial angle closure, and an increase in anterior chamber angle width and anterior chamber depth in PACG eyes without cataract.

Intraocular pressure profiles during femtosecond laser-assisted cataract surgery.

PURPOSE: To document the intraocular pressure (IOP) profiles during femtosecond laser-assisted cataract surgery. SETTING: Refractive cataract surgery center. DESIGN: Prospective case series. METHODS: Intraocular pressure was measured using a handheld portable applanation tonometer (Tono-Pen Avia) during femtosecond laser-assisted cataract surgery using the Victus platform. RESULTS: Forty-one eyes of 35 patients were recruited. The mean age of the patients was 70.5 years ± 8.2 (SD) (range 51 to 85 years). The mean IOP before, during, and after suction was 17.2 ± 3.2 mm Hg (range 10 to 23 mm Hg), 42.1 ± 10.8 mm Hg (range 20 to 55 mm Hg), and 13.8 ± 3.4 mm Hg (range 9 to 25 mm Hg), respectively. The mean difference between IOP before and during suction was 25.0 ± 11.3 mm Hg (range 5 to 43 mm Hg) (P<.01, Wilcoxon signed-rank test). The mean difference between IOP during and after suction was -28.7 ± 10.8 mm Hg (range -45 to -10 mm Hg) (P<.01, Wilcoxon signed-rank test). The mean suction duration was 216 ± 15 seconds (range 180 to 245 seconds). CONCLUSIONS: The increase in IOP during the suction phase of femtosecond laser-assisted cataract surgery was statistically significant compared with the baseline IOP. Caution should be taken in patients with ocular conditions that are vulnerable to IOP fluctuation. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Phacoemulsification versus trabeculectomy in medically uncontrolled chronic angle-closure glaucoma without cataract.

OBJECTIVE: To compare phacoemulsification versus trabeculectomy with adjunctive mitomycin C in medically uncontrolled chronic angle-closure glaucoma (CACG) without cataract. DESIGN: Prospective, randomized clinical trial. PARTICIPANTS: Fifty medically uncontrolled CACG eyes without cataract of 50 patients. INTERVENTION: Patients were randomized into undergoing either phacoemulsification or trabeculectomy with adjunctive mitomycin C. After surgery, patients were followed up every 3 months for 2 years. MAIN OUTCOME MEASURES: Intraocular pressure (IOP) and requirement for glaucoma drugs. RESULTS: Twenty-six CACG eyes were randomized to receive phacoemulsification, and 24 eyes underwent trabeculectomy with mitomycin C. Phacoemulsification and trabeculectomy resulted in significant and comparable IOP reduction at 24 months after surgery (reduction of 8.4 mmHg or 34% for phacoemulsification vs. 8.9 mmHg or 36% for trabeculectomy; P=0.76). Over first 24 months, trabeculectomy-treated eyes required on average 1.1 fewer drugs than phacoemulsification-treated eyes (P<0.001). However, trabeculectomy was associated with significantly more surgical complications than phacoemulsification (46% vs. 4%; P=0.001). Eight (33%) of 24 trabeculectomy eyes demonstrated cataract during follow-up. CONCLUSIONS: Both phacoemulsification and trabeculectomy are effective in reducing IOP in medically uncontrolled CACG eyes without cataract. Trabeculectomy is more effective than phacoemulsification in reducing dependence on glaucoma drugs, but is associated with more complications. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Cataract Surgery in Eyes with Previous Glaucoma Surgery: Pearls and Pitfalls.

The problem of cataract management in the patients of glaucoma who have undergone fltering surgery is a challenging proposition for any surgeon, as the surgery can lead to several complications in the already compromised eye. As glaucoma requires lifelong management, the development of cataract is a significant concern because its treatment may lead to loss of intraocular pressure (IOP) control. This review aims to highlight the intra- and postoperative measures that may increase the chances of bleb survival following cataract surgery. How to cite this article: Dada T, Bhartiya S, Baig NB. Cataract Surgery in Eyes with Previous Glaucoma Surgery: Pearls and Pitfalls. J Current Glau Prac 2013;7(3):99-105.