PRELIMINARY-REPORT OF SUTURELESS PHACOTRABECULECTOMY THROUGH A MODIFIED SELF-SEALING SCLERAL TUNNEL INCISION

A method of combined cataract extraction and trabeculectomy using phac oemulsification through a modified 5 mm sutureless scleral tunnel inci sion is described. In eight patients who were followed for a minimum o f five months in an initial series, the intraocular pressure (IOP) dec reased to less than 19 mm Hg; six achieved this result at six months o n no medication. The IOP decreased from a mean of 30.88 mm Hg preopera tively to 13.75 mm Hg at two months and 14.00 mm Hg at six months. The preoperative mean of 3.63 antiglaucoma medications per patient decrea sed to 0.25 postoperatively. Although all patients had advanced glauco matous optic neuropathy with a preoperative mean cup/disc ratio of 0.7 9, visual acuity improved in six patients; four patients had an acuity of 20/40 or better at both one week and two months. Surgically induce d astigmatism averaged 0.57 diopter (D) at two months, with a mean ast igmatic shift of 0.08 D with the rule at two months and 0.41 D with th e rule at three months. No hypotonous or flat anterior chambers were e ncountered; there were visible blebs in seven patients at six months. The sutureless phacotrabeculectomy preserves all the advantages of sma ll incision phacoemulsification and appears to be a safe and effective combined procedure for IOP control in glaucoma patients with cataract s.