Fig. 35-25  This patient had an upper nasal temporal extraction through a miotic pupil to preserve the filtering bleb. Five sphincterotomies were performed. Even so, small pupillary tears between the sphincterotomies can be seen. The laxity of the temporal iris allowed a small amount of pupillary capture to occur even though posteriorly angled haptics were used. This capture was not evident until 2 weeks after surgery.

Fig. 35-26  This patient had radial iridotomy performed through peripheral iridectomy existing from previous trabeculectomy surgery. She had a revision of the existing trabeculectomy because of poor filtration at the time of cataract surgery and posterior chamber IOL implantation (see Fig. 35-28).

Cataract surgery with pre-existing filtration bleb

The great advantage of the small-incision cataract procedure is that it can be used adjacent to a pre-existing filtering bleb in the superior quadrants, or temporally through clear cornea. As discussed earlier, a certain loss of IOP control from impaired bleb function should be anticipated after cataract surgery. Sometimes the bleb can be ‘reinvigorated’ with 25-gauge needling at the time of the surgery, disrupting the episcleral adhesions that demarcate the bleb and

expanding the potential subconjunctival space for filtration. Also, at the conclusion of the cataract/IOL operation, the internal ostium of the trabeculectomy can be penetrated either (1) by a needle in the subconjunctival space, through (or under, if visualized) the scleral flap, and into the anterior chamber, or (2) by a transcameral goniotomy knife or long needle across the chamber into the bleb itself. Subconjunctival 5-FU or intra-bleb mitomycin-C,166 or a mitomycin-soaked (0.5 mg/cc) cellulose sponge laid atop the bleb for 5 minutes can be administered.167

When an ECCE procedure is undertaken with a preexisting bleb, the larger incision and its healing are more likely to

adversely affect the bleb’s survival. If the bleb is functioning well, it is best avoided by removing the cataract via a temporal or clear corneal incision. If the bleb is functioning poorly, filtration may be enhanced at the time of surgery by revising the filtration site (Fig. 35-28).

Although we now advocate mastery of the more recently

described ECCE small-incision techniques performed temporally,163,164 the classic ECCE temporal extraction is illustrated

in Figure 35-24. When viewed from the front, the corneoscleral junction is an ellipse with the long axis in the horizontal meridian. Thus a temporal incision is further from the center of the pupil, making expression of the nucleus more difficult if the pupil fails to dilate because the nucleus becomes trapped behind the iris. Excessive pressure will rupture the zonules. A sector iridectomy in this area is undesirable because it is not covered by the lid and will result in reflections off the edge of the lens. One option is to place a sector iridectomy far enough superiorly as to be covered by the

lid.This is possible if the original filtration site is in the upper nasal quadrant. Another possibility is to perform a radial iridectomy to allow delivery of the nucleus and then suture the pillars of the iris together with a 10-0 Prolene suture. A third option is to use an irrigating vectus to retract the iris and deliver the nucleus. Once the nucleus is expressed, the rest of the procedure can be performed as usual.

A superior corneal incision allows a superior iridectomy and may be more familiar to the surgeon. If the bleb is positioned posteriorly away from the limbus, a small fornix-based flap can be created, and the procedure varies little from a routine extraction. If the bleb has migrated into the cornea, the incision should be anterior to it and more vertical than beveled. A beveled incision will enter the anterior chamber too centrally and have a short chord length that causes difficulty in expressing the nucleus. More sutures are usually required to close a vertical incision as compared with a beveled incision.

References

1.Goldsmith J,Ahmed I, Crandall A: Nonpenetrating glaucoma surgery. In: Smith S, editor: Ophthalmology Clinics of North America: glaucoma, Philadelphia, Saunders, pp 443–460, 2005.

2.Gimbel H, Keamy J:Alternative techniques to be used with cataract surgery. In: Coleman A, Morrison J, editors: Management of cataracts and glaucoma, London,Taylor & Francis, pp 129–135, 2005.

3.Jampel HD: Methodologic rigor of clinical trials on surgical management of eyes with coexisting cataract and glaucoma, Ophthalmology 109:1892, 2002.

4.Hylton C, et al: Cataract after glaucoma filtration surgery,Am J Ophthalmol 135:231, 2003.

5.Friedman DS, et al: Surgical strategies for coexisting glaucoma and cataract: an evidence-based update, Ophthalmology 109:1902, 2002.

6.Jampel HD, et al: Effect of technique on intraocular pressure after combined cataract and glaucoma

surgery: an evidence-based review, Ophthalmology 109:2215, 2002.

7.Gimbel HV, et al: Intraocular pressure response to combined phacoemulsification and trabeculotomy ab externo versus phacoemulsification alone in primary open-angle glaucoma, J Cataract Refract Surg 21:653, 1995.

8.Bloomberg LB: Modified trabeculectomy/ trabeculotomy with no-stitch cataract surgery, J Cataract Refract Surg 22:14, 1996.

9.Honjo M, et al:Trabeculotomy ab externo, cataract extraction, and intraocular lens implantation: preliminary report, J Cataract Refract Surg 22:601, 1996.

10.Schwenn O, Grehn F: Cataract extraction combined with trabeculectomy, Ger J Ophthalmol 4:16, 1995.

11.Vass C, Menapace R: Surgical strategies in patients with combined cataract and glaucoma, Curr Opin Ophthalmol 15:61–66, 2004.

12.Verges C, Cazal J, Lavin C: Surgical strategies in patients with cataract and glaucoma, Curr Opin Ophthalmol 16:44–52, 2005.

13.Pasquale LR, Smith SG: Surgical outcome of phacoemulsification combined with the Pearce trabeculectomy in patients with glaucoma, J Cataract Refract Surg 18:301, 1992.

14.Civerchia LL, Balent A: Intraocular lens implantation in acute angle closure glaucoma associated with cataract, J Am Intraocul Implant Soc 11:171, 1985.

15.Wishart PK,Atkinson PL: Extracapsular cataract extraction and posterior chamber lens implantation in patients with primary chronic angle-closure glaucoma: effect on intraocular pressure control, Eye 3:706, 1989.

16.Gunning FP, Greve EL: Uncontrolled primary angle closure glaucoma: results of early intercapsular cataract extraction and posterior chamber lens implantation, Int Ophthalmol 15:237, 1991.

17.Acton J, et al: Extracapsular cataract extraction with posterior chamber lens implantation in primary angle-closure glaucoma, J Cataract Refract Surg 23:930, 1997.

18.Harasymowycz PJ, et al: Phacoemulsification and goniosynechialysis in the management of unresponsive primary angle closure, J Glaucoma 14:186, 2005.

19.Poliner LS, et al: Neovascular glaucoma after intracapsular and extracapsular cataract extraction in diabetic patients,Am J Ophthalmol 100:637, 1985.

20.Aiello LM, et al: Neovascular glaucoma and vitreous hemorrhage following cataract surgery in patients with diabetes mellitus, Ophthalmology 90:814, 1983.

21.Davidorf FH, Mouser JG, Derick RJ: Rapid improvement of rubeosis iridis from a single bevacizumab (Avastin) injection, Retina 26:354, 2006.

22.Grisanti S, et al: tracameral bevacizumab for iris rubeosis,Am J Ophthalmol 142:158, 2006.

23.Mason JO, Nixon PA,White MF: Intravitreal injection of bevacizumab (Avastin) as adjunctive treatment of proliferative diabetic retinopathy,Am J Ophthalmol 142:685, 2006.

24.Avery RL, et al: Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy, Ophthalmology 113:1695, 2006.

25.Pollack A, et al:The course after cataract extraction, intraocular lens implantation, and trabeculectomy for patients with diabetes, Ophthalmic Surg Lasers 27:595, 1996.

26.Weinreb R, et al: Pseudophakic pupillary block with angle-closure glaucoma in diabetic patients,Am J Ophthalmol 102:325, 1986.

27.Schlotzer-Schrehardt U, Naumann GO: Ocular and systemic pseudoexfoliation syndrome,Am J Ophthalmol 141:921, 2006.

28.Hietanen J, et al: Exfoliation syndrome in patients scheduled for cataract surgery,Acta Ophthalmol 70:440, 1992.

29.Konstas AG,Tsironi S, Ritch R: Current concepts in the pathogenesis and management of exfoliation syndrome and exfoliative glaucoma, Compr Ophthalmol Update 7:131, 2006.

30.Kuchle M, et al:Anterior chamber depth and complications during cataract surgery in eyes with pseudoexfoliation syndrome,Am J Ophthalmol 129:281, 2000.

31.Pignalosa B, et al: Considerations on posterior chamber intraocular lens implantation in patients with pseudoexfoliation syndrome, Doc Ophthalmol 71:49, 1989.

32.Raitta C, Setala K: Intraocular lens implantation in exfoliation syndrome and capsular glaucoma,Acta Ophthalmol 64:130, 1986.

33.Dosso AA, et al: Exfoliation syndrome and phacoemulsification, J Cataract Refract Surg 23:122, 1997.

34.Ang R, Rowe S, Pineda R: Pseudoexfoliation syndrome. In: Pineda R, Espaillat A, PerezV, Rowe S, editors:The complicated cataract,Thorofare, NJ, Slack, pp 39–46, 2001.

35.Jakeman CM, et al: Cataract surgery with intraocular lens implantation in Fuchs’ heterochromic cyclitis, Eye 4:543, 1990.

36.Jones NP: Extracapsular cataract surgery with and without intraocular lens implantation in Fuchs’ heterochromic uveitis, Eye 4:145, 1990.

37.Jones NP: Glaucoma in Fuchs’ heterochromic uveitis: aetiology, management and outcome, Eye 5:662, 1991.

38.PerezV, Foster C:The uveitic eye. In: Pineda R, Espaillat A, Perez S. RoweV, editors:The complicated cataract,Thorofare, NJ, Slack, pp 47–57, 2001.

39.Lit E, et al:The traumatic cataract. In: Pineda R, Espaillat A, PerezV, Rowe S, editors:The complicated cataract,Thorofare, NJ, Slack, pp 99–111, 2001.

40.Duffey RJ, et al:Anatomic study of transsclerally sutured intraocular lens implantation,Am J Ophthalmol 108:300, 1989.

41.Soong HK, et al:Techniques of posterior chamber lens implantation without capsular support during penetrating keratoplasty: a review, Refract Corneal Surg 5:249, 1989.

42.Berler DK, Friedberg MA: Scleral fixation of posterior chamber intraocular lens implants combined with vitrectomy,Trans Am Ophthalmol Soc 89:215, 1991.

43.Navia-Aray EA: Suturing a posterior chamber intraocular lens to the iris through limbal incisions: results in 30 eyes, J Refract Corneal Surg 10:565, 1994.

44.KwongY, et al: Comparison of outcomes of primary cleral-fixated vs. primary anterior chamber IOL implantation in complicated srgical cases, Ophthalmology 114:80, 2007.

45.Jensen OM, et al: Penetrating keratoplasty and transscleral fixation of posterior chamber lens,Acta Ophthalmol Scand 73:551, 1995.

46.Schein OD, et al:A randomized trial of intraocular lens fixation techniques with penetrating keratoplasty, Ophthalmology 100:1437, 1993.

47.McCluskey P, Harrisberg B: Long-term results using scleral-fixated posterior chamber intraocular lenses, J Cataract Refract Surg 20:34, 1994.

48.McIlraith I, et al: Selective laser trabeculoplasty as initial and adjunctive treatment for open-angle glaucoma, J Glaucoma 15:124, 2006.

49.Weinand FS,Althen F: Long-term clinical results of selective laser trabeculoplasty in the treatment of primary open angle glaucoma, Eur J Ophthalmol 16:100, 2006.

50.Brown SV, et al: Effect of cataract surgery on intraocular pressure reduction obtained with laser trabeculoplasty,Am J Ophthalmol 100:373, 1985.

51.Obstbaum SA, Orlando F: Glaucoma and its relationship to intraocular lens implantation,Aust N Z J Ophthalmol 17:303, 1989.

52.Shingleton B, et al:Three and five year changes in IOP after clear corneal phacoemulsification in open angle glaucoma, glaucoma suspects, and normal patients, J Glaucoma 15:494, 2006.

53.Radius RL, et al: Pseudophakia and intraocular pressure,Am J Ophthalmol 97:738, 1984.

54.Handa J, et al: Extracapsular cataract extraction with posterior chamber lens implantation in patients with glaucoma,Arch Ophthalmol 105:765, 1987.

55.Brooks AM, Gillies WE:The effect of cataract extraction with implant in glaucomatous eyes,Aust N Z J Ophthalmol 20:235, 1992.

56.McGuigan LJ, et al: Extracapsular cataract extraction and posterior chamber lens implantation in eyes with pre-existing glaucoma,Arch Ophthalmol 104:1301, 1986.

57.Calissendorff BM, Hamberg-Nystrom H: Pressure control in glaucoma patients after cataract surgery with intraocular lens, Eur J Ophthalmol 2:163, 1992.

58.Ruit S, et al:A prospective randomized clinical trial of phacoemulsification vs manual sutureless smallincision extracapsular cataract surgery in Nepal,Am J Ophthalmol 143:32, 2007.

59.Burratto L, Ferrari M: Extracapsular cataract surgery and intraocular lens implantation in glaucomatous eyes that had a filtering bleb operation, J Cataract Refract Surg 16:315, 1990.

60.Sugar H: Post-operative cataract in successfully filtering glaucomatous eyes,Am J Ophthalmol 69:740, 1970.

61.Kass M: Cataract extraction in an eye with a filtering bleb, Ophthalmology 89:871, 1982.

62.Levene R:Triple procedure of extracapsular cataract surgery, posterior chamber lens implantation, and glaucoma filter, J Cataract Refract Surg 12:385, 1986.

63.Oyakawa R, Maumenee A: Clear-cornea cataract extraction in eyes with functioning filtering blebs, Am J Ophthalmol 93:294, 1982.

64.Drolsum L, Haaskjold E: Extracapsular cataract extraction in eyes previously operated for glaucoma, Acta Ophthalmol (Copenh) 72:273, 1994.

65.Seah SK, et al: Cataract surgery after trabeculectomy, Ophthalmic Surg Lasers 27:587, 1996.

66.Crichton AC, Kirker AW: Intraocular pressure and medication control after clear corneal

phacoemulsification and AcrySof posterior chamber intraocular lens implantation in patients with filtering blebs, J Glaucoma 10:38, 2001.

67.Casson R, Rahman R, Salmon J: Phacoemulsification with IOL after trabeculectomy, J Glaucoma 11:429, 2002.

68.Klink J, et al: Filtering bleb function after clear corneal phacoemulsification: a prospective study, Br J Ophthalmol 89:597, 2005.

69.Percival SP: Glaucoma triple procedure of extracapsular cataract extraction, posterior chamber lens implantation, and trabeculectomy, Br J Ophthalmol 69:99, 1985.

70.Longstaff S, et al: Glaucoma triple procedures: efficacy of intraocular pressure control and visual outcome, Ophthalmic Surg 21:786, 1990.

71.Savage JA, et al: Extracapsular cataract extraction and posterior chamber intraocular lens implantation in glaucomatous eyes, Ophthalmology 92:1506, 1985.

72.Murchison JF Jr, Shields MB:An evaluation of three surgical approaches for coexisting cataract and glaucoma, Ophthalmic Surg 20:393, 1989.

73.Naveh N, et al:The long-term effect on intraocular pressure of a procedure combining trabeculectomy and cataract surgery, as compared

with trabeculectomy alone, Ophthalmic Surg 21:339, 1990.

74.Caprioli J, et al:Temporal corneal phacoemulsification combined with superior trabeculectomy: a controlled study,Trans Am Ophthalmol Soc 94:451, 1996.

75.Yu CB, et al: Long-term results of combined cataract and glaucoma surgery versus trabeculectomy alone in low-risk patients, J Cataract Refract Surg 22:352, 1996.

76.Park HJ, et al:Temporal corneal phacoemulsification combined with superior trabeculectomy: a retrospective case-control study,Arch Ophthalmol 115:318, 1997.

77.Hylton C, et al: Cataract after glaucoma filtration surgery,Am J Ophthalmol 135:231, 2003.

78.Ciofi G, Friedman D, Pfeiffer N: Combined cataract/ trabeculectomy. In:Werinreb R, Crowston J, editors: Glaucoma surgery: open angle glaucoma (Consensus statements 2nd Global AGIS Meeting),The Hague, Kugler, p 65, 2005.

79.Krupin T, et al: Postoperative intraocular pressure rise in open-angle glaucoma patients after cataract or combined cataract-filtration surgery, Ophthalmology 96:579, 1989.

80.Vu MT, Shields MB:The early postoperative pressure course in glaucoma patients following cataract surgery, Ophthalmic Surg 19:467, 1988.

81.Ruderman JM, et al: Combined phacoemulsification and trabeculectomy with mitomycin-C, J Cataract Refract Surg 22:1085, 1996.

82.Simmons ST, et al: Extracapsular cataract extraction and posterior chamber intraocular lens implantation combined with trabeculectomy in patients with glaucoma,Am J Ophthalmol 104:465, 1987.

83.McCartney DL, et al:The efficacy and safety of combined trabeculectomy, cataract extraction, and intraocular lens implantation, Ophthalmology 95:754, 1988.

84.Raitta C,Tarkkanen A: Combined procedure for the management of glaucoma and cataract,Acta Ophthalmol 66:667, 1988.

85.Wishart PK,Austin MW: Combined cataract extraction and trabeculectomy: phacoemulsification compared with extracapsular technique, Ophthalmic Surg 24:814, 1993.

86.Stewart WC, et al: Results of trabeculectomy combined with phacoemulsification versus trabeculectomy combined with extracapsular cataract extraction in patients with advanced glaucoma, Ophthalmic Surg 25:621, 1994.

87.Shingleton BJ, et al: Comparison of combined cataract and glaucoma surgery using planned extracapsular and phacoemulsification techniques, Ophthalmic Surg Lasers 26:414, 1995.

88.Wedrich A, et al: Comparison of results and complications following combined ECCEtrabeculectomy versus small-incision-trabeculectomy and posterior chamber lens implantation, Int Ophthalmol 20:125, 1996.

89.Tezel G, et al: Comparative results of combined procedures for glaucoma and cataract: I. Extracapsular cataract extraction versus phacoemulsification and foldable versus rigid intraocular lenses, Ophthalmic Surg Lasers 28:539, 1997.

90.Hennis HL, Stewart WC: Use of 5-fluorouracil in patients following combined trabeculectomy and cataract extraction, Ophthalmic Surg 22:451, 1991.

91.Wong P, et al: 5-Fluorouracil after primary combined filtration surgery,Am J Ophthalmol 117:149, 1994.

92.O’Grady JM, et al:Trabeculectomy, phacoemulsification, and posterior chamber lens implantation with and without 5-fluorouracil,Am J Ophthalmol 116:594, 1993.

93.Hurvitz LM: 5-FU-supplemented phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy, Ophthalmic Surg 24:674, 1993.

94.Yamagami S, et al: Risk factors for unsatisfactory intraocular pressure control in combined trabeculectomy and cataract surgery, Ophthalmic Surg Lasers 28:476, 1997.

95.Gandolfi SA,Vecchi M: 5-Fluorouracil in combined trabeculectomy and clear-cornea phacoemulsification with posterior chamber intraocular lens implantation: a one-year randomized, controlled clinical trial, Ophthalmology 104:181, 1997.

96.Joos KM, et al: One-year follow-up results of combined mitomycin-C trabeculectomy and extracapsular cataract extraction, Ophthalmology 102:76, 1995.

97.Belyea DA, et al: Midterm follow-up results of combined phacoemulsification, lens implantation, and mitomycin-C trabeculectomy procedure,

J Glaucoma 6:90, 1997.

98.Yang KJ, et al: Mitomycin-C supplemented trabeculectomy, phacoemulsification, and foldable lens implantation, J Cataract Refract Surg 23:565, 1997.

99.Shin DH, et al:Adjunctive subconjunctival mitomycin-C in glaucoma triple procedure, Ophthalmology 102:1550, 1995.

100.Cohen JS, et al:A placebo-controlled, doublemasked evaluation of mitomycin-C in combined glaucoma and cataract procedures, Ophthalmology 103:1934, 1996.

101.Carlson DW, et al:A randomized study of mitomycin augmentation in combined phacoemulsification and trabeculectomy, Ophthalmology 104:719, 1997.

102.Greenfield DS, et al: Endophthalmitis after filtering surgery with mitomycin,Arch Ophthalmol 114:943, 1996.

103.Higginbotham EJ, et al: Bleb-related endophthalmitis after trabeculectomy with mitomycin-C, Ophthalmology 103:650, 1996.

104.Ayyala RS, et al: Bleb infections: clinically different courses of ‘blebitis’ and endophthalmitis, Ophthalmic Surg Lasers 28:452, 1997.

105.Kangas TA, et al: Delayed-onset endophthalmitis associated with conjunctival filtering blebs, Ophthalmology 104:746, 1997.

106.Shin DH, et al: Primary glaucoma triple procedure with or without adjunctive mitomycin: prognostic factors for filtration failure, Ophthalmology 103:1925, 1996.

107.Anand N,Arora S, Clowes M: Mitomycin C augmented glaucoma surgery: evolution of filtering bleb avascularity, transconjunctival oozing, and leaks, Br J Ophthalmol 90:175, 2006.

108.Chang DF, Campbell JR: Intraoperative floppy iris syndrome associated with tamsulosin, J Cataract Refract Surg 31:664, 2005.

109.Schwinn DA,Afshari NA: 1-Adrenergic receptor antagonists and the iris: new mechanistic insights into floppy iris syndrome, Surv Ophthalmol 51:501, 2006.

110.Konstantatos A:Anticoagulation and cataract surgery: a review of the current literature,Anaesth Intensive Care 29:11, 2001.

111.Jonas JB, Pakdaman B, Sauder G: Cataract surgery under systemic anticoagulant therapy with coumarin, Eur J Ophthalmol 16:30, 2006.

112.Bendel RE, Phillips MB: Preoperative use of atropine to prevent intraoperative floppy-iris syndrome in patients taking tamsulosin, J Cataract

Refract Surg 32:1603, 2006.

112b. BuysYM, Chipman ML, Zack B, et al: Prospective randomized comparison of oneversus two-

site phacotrabeculectomy:Two-year results, Ophthalmology 115:1130–1133, 2008.

113.Williamson TH, et al: Combined extracapsular cataract extraction and trabeculectomy using a separated corneal section, Eye 3:547, 1989.

114.Gillies WE, Brooks AM:The results of combined cataract extraction and trabeculectomy using separate incisions,Aust N Z J Ophthalmol 20:239, 1992.

115.Gayton JL, et al: Combined cataract and glaucoma procedures using temporal cataract surgery, J Cataract Refract Surg 22:1485, 1996.

116.Tezel G, et al: Comparative results of combined procedures for glaucoma and cataract: II. Limbusbased versus fornix-based conjunctival flaps, Ophthalmic Surg Lasers 28:551, 1997.

117.Murchison JF Jr, Shields MB: Limbal-based vs fornix-based conjunctival flaps in combined extracapsular cataract surgery and glaucoma filtering procedure,Am J Ophthalmol 109:709, 1990.

118.Stewart WC, et al: Fornixvs. limbus-based flaps in combined phacoemulsification and trabeculectomy, Doc Ophthalmol 88:141, 1994.

119.Lederer CM: Combined cataract extraction with intraocular lens implant and mitomycin-augmented trabeculectomy, Ophthalmology 103:1025, 1996.

120.Berestka JS, Brown SV: Limbusversus fornix-based conjunctival flaps in combined phacoemulsification and mitomycin-C trabeculectomy surgery, Ophthalmology 104:187, 1997.

121.Lieberman M: Complications of glaucoma surgery. In: Charlton J,Weinstein G, editors: Ophthalmic surgery complications, Philadelphia, LippincottRaven, 1995.

122.Schumer RA, Odrich SA:A scleral tunnel incision for trabeculectomy,Am J Ophthalmol 120:528, 1995.

123.Mohr A: No-stitch phacotrabeculectomy using modified punch technique, Klin Monatsbl Augenheilkd 210:19, 1997.

124.Khaw PT, Dahlman A, Mireskandari K:Trabe­ culectomy technique, Glaucoma Today 3:22, 2005.

124b. Stalmans I, Gillis A, Lafaut AS, Zeyen T: Safe trabeculectomy technique: long term outcome, Br J Ophthalmol 90:44–47, 2006.

124c. Khaw PT, Shah P:Trabeculectomy. In: Shaarawy T, Mermoud A, editors:Atlas of Glaucoma Surgery, Anshan Tunbridge Wells, UK, pp 11–31, 2006.

125.Mora JS, et al:Trabeculectomy with intraoperative sponge 5-fluorouracil, Ophthalmology 103:963, 1996.

126.Prata J, et al: Site of mitomycin-C application during trabeculectomy, J Glaucoma 3:296, 1994.

127.CostaVP, et al: Low-dose mitomycin-C trabeculectomy in patients with advanced glaucoma, J Glaucoma 5:193, 1996.

128.Cheung JC, et al: Intermediate-term outcome of variable dose mitomycin-C filtering surgery, Ophthalmology 104:143, 1997.

129.Cohen J:The role of mitomycin treatment and duration and previous intraocular surgery on the success of trabeculectomy surgery, J Glaucoma 6:3, 1997.

130.Espaillat A, Rowe S:The small pupil. In: Pineda R, Espaillat A, PerezV, Rowe S, editors:The complicated cataract,Thorofare, NJ, Slack, p 15, 2001.

131.Novak J: Flexible iris hooks for phacoemulsification, J Cataract Refract Surg 23:828, 1997.

132.Jaffe N, et al: Cataract surgery and its complications, 6th edn, St Louis, Mosby, 1997.

132a. Agarwal A, Malyugin B, Kumar DA, Jacob S, Agarwal A, Laks L: Modified Malyugin ring iris expansion technique in small-pupil cataract surgery with posterior capsule defect, J Cataract Refract Surg May; 34(5):724–726, 2008.

133.Gimbel H: Divide and conquer nucleofractis phacoemulsification: development and variations, J Cataract Refract Surg 17:281, 1991.

134.Koch P, Katzen L: Stop and chop phacoemulsification, J Cataract Refract Surg 20:566, 1994.

135.Davison JA: Phacoemulsification in glaucomatous eyes. In:Thomas JV, Belcher CD, Simmons RJ, editors: Glaucoma surgery, St Louis, Mosby, 1992.

136.Lyle A, Jin J: Comparison of a 3- and 6-mm incision in combined phacoemulsification and trabeculectomy,Am J Ophthalmol 111:189, 1991.

137.Wedrich A, et al: Combined small-incision cataract surgery and trabeculectomy: technique and results, Int Ophthalmol 16:409, 1992.

138.Wedrich A, et al: Long-term results of combined trabeculectomy and small incision cataract surgery, J Cataract Refract Surg 21:49, 1995.

139.Allan BD, Barrett GD: Combined small incision phacoemulsification and trabeculectomy, J Cataract Refract Surg 19:97, 1993.

140.Stewart WC, et al:Three-millimeter versus 6-mm incisions in combined phacoemulsification and trabeculectomy, Ophthalmic Surg Lasers 27:832, 1996.

141.Wand M: Combined phacoemulsification, intraocular lens implant, and trabeculectomy with intraoperative mitomycin-C: comparison between 3.2- and 6.0-mm incisions, J Glaucoma 5:301, 1996.

142.Jayamanne DG, et al:The outcome of 2.3 mm incision combined phacoemulsification, trabeculectomy and lens implantation of nonfoldable intraocular lenses, Eye 11:91, 1997.

143.Kosmin AS, et al: Silicone versus poly(methyl methacrylate) lenses in combined phacoemulsification and trabeculectomy, J Cataract Refract Surg 23:97, 1997.

144.Lemon LC, et al: Comparative study of silicone versus acrylic foldable lens implantation in primary glaucoma triple procedure, Ophthalmology 104:1708, 1997.

145.Stutzman R, Stark W: Surgical technique for suture fixation of an acrylic IOL in the absence of capsule support, J Cataract Refract Surg 29:1658, 2003.

146.Meyer MA, et al: Lens choice in complicated cataract extraction in glaucomatous eyes, J Glaucoma 6:56, 1997.

147.Shingleton BJ, Kalina PH: Combined phacoemulsification, intraocular lens implantation, and trabeculectomy with a modified scleral tunnel and single-stitch closure, J Cataract Refract Surg 21:528, 1995.

148.Arnold PN: No-stitch phacotrabeculectomy, J Cataract Refract Surg 22:253, 1996.

149.Cohen JS, Osher RH: Releasable scleral flap suture. In: Krupin T,Wax MB, editors: New techniques in glaucoma surgery, Philadelphia,WB, Saunders, 1988.

150.Wilson RP: Releasable sutures in filtration surgery. In: Sherwood MB, Spaeth GL, editors: Complications of glaucoma surgery,Thorofare, NJ, Slack, 1990.

151.Johnstone MA, et al:A releasable scleral-flap tamponade suture for guarded filtration surgery, Arch Ophthalmol 111:398, 1993.

152.Kolker AE, et al:Trabeculectomy with releasable sutures,Arch Ophthalmol 112:62, 1994.