CATARACT EXTRACTION AFTER FILTERING SURGERY
When extraction of the cataract becomes necessary in an eye with a functioning filtering bleb, the cataract incision should be positioned to maximize bleb survival. Phacoemulsification typically has less effect on the postoperative IOP elevation than ECCE, although both approaches can be associated with an increase in IOP (42,99,100). Intraoperative complications during cataract surgery, especially vitreous loss, have been associated with bleb failure (99). Phacoemulsification and a foldable PC IOL through a clear corneal incision with or without a corneal suture, has become a popular approach for cataract surgery in eyes with an established filtering bleb (Fig. 44.2). Most surgeons prefer to use a temporal corneal incision (101) for phacoemulsification, although a clear corneal incision elsewhere, depending on the location of the filtering bleb, may be used. These basic methods are generally comparable with regard to preserving function of the filtering bleb, although most eyes will have a slightly higher IOP postoperatively (41), and many will require more glaucoma medication. As would be expected, eyes with a well-controlled IOP following trabeculectomy appear to have a better prognosis after cataract surgery (102).
