Phacotrabeculectomy with "smile" incision, punch, and single releasable suture

To describe and prospectively evaluate a technique of phacotrabeculectomy consisting of a "smile" wound, corneal punch, and tight closure of the scleral flap with a single releasable suture.

A cohort of 25 patients underwent this procedure performed by a single surgeon. The surgical technique is described and the first year of follow-up is evaluated.

Mean intraocular 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 immediate postoperative complications was low, especially those related to hypotony (wound leak, shallow anterior chamber, fibrinous uveitis). There was a 50% incidence of postoperative IOP spikes of greater than 26 mm 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).

The tight scleral flap and routine release of the releasable suture on the third postoperative day reduce immediate postoperative complications compared with other studies, with the exception of IOP spikes. The lack of aqueous flow in the immediate postoperative phase may be a factor in the failure rate, which is higher than expected.