PHACOTRABECULECTOMY WITH SMILE INCISION, PUNCH, AND SINGLE RELEASABLESUTURE

BACKGROUND AND OBJECTIVE: To describe and prospectively evaluate a tec hnique of phacotrabeculectomy consisting of a ''smile'' wound, corneal punch, and tight closure of the scleral Bap With a single releasable suture. PATIENTS AND METHODS: A cohort of 25 patients underwent this p rocedure performed by a single surgeon. The surgical technique is desc ribed and the first year of follow-up is evaluated. RESULTS: Mean intr aocular pressure (IOP) was 25.4 mm Hg preoperatively and 16.2 mm Hg at a mean follow-up of 10.2 months (a fall of 36%). Incidence of immedia te postoperative complications was low, especially those related to hy potony (wound leak, shallow anterior chamber, fibrinous uveitis). Ther e was a 50% incidence of postoperative IOP spikes of greater than 26 m m Hg. Three cases were deemed partial failures at 1 year (IOP < 21 mm Hg on medical treatment), and three cases were complete failures (IOP > 21 mm Hg or further surgery required). CONCLUSION: The tight scleral flap and routine release of the releasable suture on I-he third posto perative day reduce immediate postoperative complications compared wit h other studies, with the exception of IOP spikes. The lack of aqueous flow in the immediate postoperative phase may be a factor in the fail ure rate, which is higher than expected.