[No-stitch phacotrabeculectomy using modified punch technique]

Combined cataract-glaucoma surgery is associated with a higher rate of intra- and postoperative undesired reactions than if each procedure is performed separately. We therefore investigated weather use of a special punch for trephination of a fistula opening in the area of the scleral tunnel could both reduce the rate of complications and improve regulations of pressure.

The modified procedure was performed in 22 patients. After phacoemulsification and implantation of a foldable lens through a 3.3 mm wide scleral tunnel, a 1.1 mm wide trephination opening was made in the lower wound flap using a specially designed punch. Without stitching the tunnel, the fistula was checked and the operation ended by suturing the limbus-based conjunctival flap.

The rate of immediate postoperative complications was markedly reduced by that procedure. A postoperative hyphema did not occur in any patient. The incidence of fibrin exsudation was also considerably diminished. With regard to the medium-term stabilization of pressure, our method was slightly better than those reported in other studies.

In light of the good results achieved with the modified procedure described here for the first time, a rethinking of the strict indications for this type of intervention in patients with cataract and simultaneous open-angle glaucoma is warranted.