Insertion of a foldable hydrophobic IOL through the trabeculectomy fistula in cases with microincision cataract surgery combined with trabeculectomy.
BACKGROUND
The use of conventional foldable hydrophobic intraocular lenses (IOLs) in microincision cataract surgery (MICS) currently requires wound enlargement. We describe a combined surgical technique of MICS and trabeculectomy with insertion of a foldable IOL through the trabeculectomy fistula.


METHODS
After completion of MICS through two side port incisions, a 3.2 mm keratome is used to enter the anterior chamber under the previously outlined scleral flap. An Acrysof multi piece IOL (Alcon labs, Fort Worth, Tx) is inserted into the capsular bag through this incision. The scleral flap is then elevated and a 2 x 2 mm fistula made with a Kelly's punch. The scleral flap and conjunctival closure is performed as usual.


RESULTS
Five patients with primary open angle glaucoma with a visually significant cataract underwent the above mentioned procedure. An IOL was implated in the capsular bag in all cases with no intraperative complications. After surgery, all patients obtained a best corrected visual acuity of 20/20, IOL was well centered at 4 weeks follow up. The mean IOP (without any antiglaucoma medication) was 13.2 + 2.4 mm Hg at 12 weeks with a well formed diffuse filtering bleb in all the cases.


CONCLUSIONS
The technique of combining MICS with trabeculectomy and insertion of a foldable IOL through the trabeculectomy fistula is a feasible and valuable technique for cases which require combined cataract and glaucoma surgery.
Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India. tanujdada@hotmail.com
Tanuj
T
Dada
Rajamani
R
Muralidhar
Harinder S
HS
Sethi
D002386:Cataract / Q000150:complications; D002387:Cataract Extraction / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure; D019654:Lens Implantation, Intraocular / Q000379:methods*; D007910:Lenses, Intraocular; D008866:Microsurgery; D014130:Trabeculectomy; D016896:Treatment Outcome; D014792:Visual Acuity