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Trabeculectomy is associated with increased risk of cataract formation

NEW YORK, (Reuters Health) – In patients enrolled in the Advanced Glaucoma Intervention Study (AGIS), trabeculectomy is associated with an increased risk of cataract formation in, according to a report in the December issue of the Archives of Ophthalmology.

"The AGIS has been following 789 eyes in 591 patients with medically uncontrolled open-angle glaucoma," Dr. Douglas E. Gaasterland, of Georgetown University, Washington, DC, and colleagues note. "From 1980 to 1992, these eyes were randomly assigned to either an argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy treatment sequence or a trabeculectomy-ALT-trabeculectomy sequence."

The researchers used Cox regression analysis to examine risk factors for cataract formation during 7 to 11 years of follow-up. Overall, 54.3% of the eyes developed cataracts.

"A first trabeculectomy, whether as the first or second AGIS intervention, increased the overall risk of cataract by 78% (risk ratio [RR] = 1.78; p < 0.001)," the investigators report.

When analyzed according to postoperative complications of trabeculectomy, "the increased risk of cataract for eyes with a first trabeculectomy reduced to 47% when complications did not occur (RR = 1.47; p = 0.003) and increased to 104% when complications did occur (RR = 2.04; p < 0.001)," the team reports.

Diabetes (RR =1.47; p = 0.004) and age (RR = 1.07 per year of age; p < 0.001) at baseline were also associated with an increased risk of cataract formation, according to the report. The investigators also observed an association between marked inflammation (RR = 3.29; p < 0.001) and flat anterior chamber (RR = 1.80; p = 0.004) and an increased risk of cataract formation.

Arch Ophthalmol 2001;119:1771-1780.

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