Development of cataract after trabeculectomy

Vesti, Eija

doi:10.1111/j.1755-3768.1993.tb08599.x

Cited by 51 publications

(14 citation statements)

References 18 publications

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“…First, subject age at the time of cataract surgery was significantly lower in the CAT group than in the other two groups. This was likely the result of trabeculectomy‐associated cataract progression, which has been shown to occur in 8% to 47% of patients undergoing trabeculectomy. In our study, it was not clear whether or not previous trabeculectomy affected cataract formation, but the lower patient age in the CAT group suggests that prior trabeculectomy can have a significant influence on cataract progression.…”

Section: Discussionmentioning

confidence: 99%

Effect of trabeculectomy on the accuracy of intraocular lens calculations in patients with open‐angle glaucoma

Bae

Lee

Kim

et al. 2016

Clinical Exper Ophthalmology

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Section: Discussionmentioning

confidence: 99%

Effect of trabeculectomy on the accuracy of intraocular lens calculations in patients with open‐angle glaucoma

Bae

Lee

Kim

et al. 2016

Clinical Exper Ophthalmology

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“…The increased flow rate of aqueous humour following glaucoma filtration surgery in very likely to increase the oxygen delivery to the lens, and may contribute to nuclear sclerosis cataract formation (148)(149)(150)(151)(152)(153)(154).…”

Section: Cataractmentioning

confidence: 99%

Physiology of vitreous surgery

Stefánsson

2008

Graefes Arch Clin Exp Ophthalmol

253

198

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Vitreous surgery has various physiological and clinical consequences, both beneficial and harmful. Vitrectomy reduces the risk of retinal neovascularization, while increasing the risk of iris neovascularization, reduces macular edema and stimulates cataract formation. These clinical consequences may be understood with the help of classical laws of physics and physiology. The laws of Fick, Stokes-Einstein and Hagen-Poiseuille state that molecular transport by diffusion or convection is inversely related to the viscosity of the medium. When the vitreous gel is replaced with less viscous saline, the transport of all molecules, including oxygen and cytokines, is facilitated. Oxygen transport to ischemic retinal areas is improved, as is clearance of VEGF and other cytokines from these areas, thus reducing edema and neovascularization. At the same time, oxygen is transported faster down a concentration gradient from the anterior to the posterior segment, while VEGF moves in the opposite direction, making the anterior segment less oxygenated and with more VEGF, stimulating iris neovascularization. Silicone oil is the exception that proves the rule: it is more viscous than vitreous humour, re-establishes the transport barrier to oxygen and VEGF, and reduces the risk for iris neovascularization in the vitrectomized-lentectomized eye. Modern vitreous surgery involves a variety of treatment options in addition to vitrectomy itself, such as photocoagulation, anti-VEGF drugs, intravitreal steroids and release of vitreoretinal traction. A full understanding of these treatment modalities allows sensible combination of treatment options. Retinal photocoagulation has repeatedly been shown to improve retinal oxygenation, as does vitrectomy. Oxygen naturally reduces VEGF production and improves retinal hemodynamics. The VEGF-lowering effect of photocoagulation and vitrectomy can be augmented with anti-VEGF drugs and the permeability effect of VEGF reduced with corticosteroids. Starling's law explains vasogenic edema, which is controlled by osmotic and hydrostatic gradients between vessel and tissue. It explains the effect of VEGF-induced vascular permeability changes on plasma protein leakage and the osmotic gradient between vessel and tissue. At the same time, it takes into account hemodynamic changes that affect the hydrostatic gradient. This includes the influence of arterial blood pressure, and the effect oxygen (laser treatment) has in constricting retinal arterioles, increasing their resistance, and thus reducing the hydrostatic pressure in the microcirculation. Reduced capillary hydrostatic pressure and increased osmotic gradient reduce water fluxes from vessel to tissue and reduce edema. Finally, Newton's third law explains that vitreoretinal traction decreases hydrostatic tissue pressure in the retina, increases the pressure gradient between vessel and tissue, and stimulates water fluxes from vessel into tissue, leading to edema.

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“…This includes both those with naturally ageing cataract and in some cases from the effect of conventional glaucoma treatment. [23][24][25] Naturally, it can also improve the visual function in patients with hypermetropia (found in the majority of PACG patients), by correcting this refractive error. Although admirable, the remit of the EAGLE study 8 does not address the whole spectrum of angle closure and mainly concerns quality of life rather than long-term glaucoma control.…”

Section: Discussionmentioning

confidence: 99%