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Consultation Section

Cataract surgical problem: Reply

Baïkoff, Georges MD

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Journal of Cataract & Refractive Surgery: March 2000 - Volume 26 - Issue 3 - p 318-319
doi: 10.1016/S0886-3350(00)00339-4
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In routine practice, this kind of case is rare. Personally, I see 1 to 3 new cases per year. Usually, they are referred by other ophthalmologists for treatment.

The endothelial cell density is missing, and I do not know whether the patient has blurred vision in the morning. If so, her endothelial density is poor and it is time for a corneal transplantation.

If there is no morning blur and the endothelial cell density is adequate, it is possible to treat the cataract and the glaucoma during the same procedure. My approach would be to perform phacotrabeculectomy in the 2 o'clock meridian. After cleaving the scleral flap, I would apply local mitomycin for 3 minutes and then rinse copiously with a balanced salt solution. The trabeculectomy opening should be carried forward to the cornea to be very anterior and far from the angle where goniosynechcias could develop in the future. Phacoemulsification would be performed as usual, using either a PMMA or foldable IOL.

If a corneal transplantation is required, I would first create the scleral flap without opening the anterior chamber. Then, I would perform the penetrating corneal transplantation with an open-sky extracapsular cataract extraction and place a posterior chamber IOL. After the graft, I would finish the trabeculectomy.

I have done combined procedures in some similar eyes, and the results were very satisfying.

© 2000 by Lippincott Williams & Wilkins, Inc.