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.