Dada Tanuj, Muralidhar Rajamani, Sethi Harinder S
Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India.
BMC Ophthalmol. 2006 Mar 19;6:14. doi: 10.1186/1471-2415-6-14.
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.
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.
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.
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.
在微切口白内障手术（MICS）中使用传统的可折叠疏水人工晶状体（IOL）目前需要扩大切口。我们描述了一种MICS与小梁切除术相结合的手术技术，即通过小梁切除瘘口插入可折叠IOL。
通过两个侧端口切口完成MICS后，使用3.2毫米角膜刀在先前划定的巩膜瓣下进入前房。将一片式丙烯酸酯IOL（爱尔康实验室，沃思堡，德克萨斯州）通过此切口插入囊袋。然后抬起巩膜瓣，用凯利打孔器制作一个2×2毫米的瘘口。按常规进行巩膜瓣和结膜闭合。
5例患有具有明显视力损害的白内障的原发性开角型青光眼患者接受了上述手术。所有病例均在囊袋内植入IOL，无术中并发症。术后，所有患者的最佳矫正视力均达到20/20，随访4周时IOL居中良好。12周时，平均眼压（未使用任何抗青光眼药物）为13.2±2.4毫米汞柱，所有病例均形成良好的弥漫性滤过泡。
对于需要联合白内障和青光眼手术的病例，将MICS与小梁切除术以及通过小梁切除瘘口插入可折叠IOL的技术是一种可行且有价值的技术。
