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ABSTRACT
A review of 15 cases suggests that posterior-lip sclerectomy can be performed safely with extracapsular cataract extraction (ECCE) and posterior chamber lens implantation. The anterior chamber was filled with viscoelastic at the end of each procedure; no case required reoperation for shallow chamber or hypotony. The mean intraocular pressure after 1 year was 12.1 mm Hg. The astigmatism induced by the triple procedure did not differ significantly from that caused by ECCE alone during the initial 2 postoperative years. A new mathematical model that describes the change over time of postoperative astigmatism associated with these procedures is described.
When Cairns described trabeculectomy in 1968, he thought that excision of a block of trabecular meshwork opened Schlemm's canal to facilitate outflow of aqueous. Thus, he advocated resuturing the scierai flap at the completion of the procedure.1 Subsequently, it was recognized that aqueous passes beneath the scierai flap to the subconjunctival space and that the sclera! flap tamponades aqueous outflow, helping to prevent postoperative hypotony and shallow or flat anterior chamber.2 If aqueous runoff is insufficient, the intraocular pressure (IOP) may be high, requiring release of one or more of the scierai flap sutures. The unsutured or loosely sutured sclera] flap may lead to significant postoperative astigmatism, especially if the wound is enlarged for extracapsular cataract extraction (ECCE)A4
Full-thickness filtration procedures are less likely than guarded trabeculectomies to be complicated by postoperative hypertension; however, they are more likely to be complicated by postoperative hypotony.5'8 Since the incision for a full-thickness fistula is smaller than the scierai flap created for a trabeculectomy, a combined full-thickness filtration procedure and cataract extraction may induce less astigmatism than a combined trabeculectomy and cataract extraction. Clinical studies have shown that guarded trabeculectomy may be performed safely with ECCE,3-4-9-11 but there is little information on the safety and efficacy of a combined full-thickness filtration procedure and ECCE.
We reviewed our initial experience with combined posterior-lip sclerectomy, ECCE, and posterior chamber lens (PC-IOL) implantation (ECCE/PC-IOL). Viscoelastic was used routinely to help prevent shallowing of the anterior chamber. Initially, only patients with advanced glaucoma, who might be sensitive to postoperative pressure spikes, were selected for the procedure. In most cases, lower than normal IOPs were desired.
METHODS
Patients: Triple Procedure
The study...