COMBINED PHACOEMULSIFICATION, INTRAOCULAR-LENS IMPLANTATION, AND TRABECULECTOMY WITH A MODIFIED SCLERAL TUNNEL AND SINGLE-STITCH CLOSURE

In most combined phacoemulsification and filtration surgery, the stand ard tunnel incision is altered to create a scleral flap, usually a lim bal-based scleral flap with radial suture closure. We describe a new t echnique that has the advantages of both scleral tunnel architecture a nd horizontal suture closure. It creates a scleral groove tangential t o the limbus and a standard scleral tunnel. Phacoemulsification and in traocular lens implantation are performed under the scleral tunnel. A 10-0 nylon horizontal suture is positioned for scleral tunnel closure and looped aside. A central ''T'' relaxing incision is made at the mid point of the scleral tunnel up to the posterior insertion of conjuncti va, A punch sclerectomy is performed. The 10-0 nylon horizontal suture is tied. The conjunctiva is closed and bleb elevation is confirmed vi a deepening through a corneal paracentesis incision. The results in an initial series of 24 consecutive eyes followed for a mean of seven mo nths are presented: Mean visual acuity improved from 20/70 to 20/30 an d mean intraocular pressure reduction was 5.0 +/- 2.4 mm Hg (standard deviation). By preserving standard scleral tunnel architecture and sin gle horizontal suture closure, this technique permits rapid visual rec overy and accelerated return to full activity. It also permits postope rative titration of aqueous outflow by laser suture lysis, if indicate d. Against-the-rule astigmatic drift associated with limbal-based scle ral flaps and antimetabolite therapy may be minimized.