Cataract and trabeculectomy

Cataract surgery is really successful at removing a hazy lens from your eye, replacing it with a new artificial lens, and getting your vision back to its best possible. Glaucoma patients get more cataract sooner in life than those without glaucoma. Part of this is just the disease, and part is due to the fact that glaucoma treatments speed up cataract. Cataract happens faster whether you are treated with drops or with surgery. Remember: if you don’t stop glaucoma damage, you will lose vision you cannot get back. Cataract vision loss is reversible.

When patients who have had trabeculectomy are studied, they need cataract surgery in the next five years more often than others. So, if there is already cataract there in an eye that is in need of trabeculectomy, we often do the two operations rolled into one. The end result success rate for the combined operation is about the same as for persons who had trabeculectomy alone, later got cataract, then had the second operation to remove cataract. And, combining them together means only one operation, not two. But, doing them together adds complexity and a few more potential problems, so you don’t want to take out the lens (cataract) unless you’ve considered the options with the surgery.

There is some evidence that removing cataract by surgery actually lowers eye pressure a bit. Not as much as having a full additional trabeculectomy, however. So, if you need a substantially lower target pressure and you have a removable cataract, the cataract operation alone will not always do the trick. Of course, if you can avoid the combination trabeculectomy, you avoid the risks of trabeculectomy, like too low pressure and late infection. You will want to consider this carefully with the surgeon before deciding.

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