Cutting Edge Glaucoma

The Video presenting Visco-Trab operation combined with clear cornea temporal phacoemulsification and in-the-bag foldable intraocular lens implantation in a patient with advanced primary open-angle glaucoma and posterior subcapsular cataract.Steps of combined Visco-Trab operation include fornix-based conjunctival flap and subconjunctival Mitomycin C 0.3 mg for 3 min followed by through wash with BSS. A 4x4mm lamellar scleral flap (1/3-1/2 of thickness) extending 1mm in clear cornea. Deep scleral flap dissection 0.5 mm inside edge, leaving thin scleral over choroid. Exposure & deroofing of Schlemm’s canal. When the glaucoma procedure is combined with phacoemulsification, once the canal is deroofed, the surgeon moves to the temporal side to do the cataract operation through a clear-cornea incision. At the end of the phaco procedure, the AC is reformed and the corneal wound is secured by one 10/0 Nylon suture and the surgeon reverts back to upper position to complete the filtering operation. Excision of deep scleral flap creating a scleral lake. Dilation of SC on either side with sodium hyaluronate. Penetrating trabeculectomy (1×2 mm) and wide peripheral iridectomy were done followed by water tight closure of lamellar scleral flap and conjunctival flap.