Objective: To describe the clinical characteristics and surgical techniques of small-incision phacoemulsification in eyes with previous trabeculectomy.
Methods: A prospective descriptive study was conducted on 35 eyes of 31 patients who underwent small-incision phacoemulsification after trabeculectomy at the Vietnam National Eye Hospital. Study variables included preoperative clinical characteristics, phacoemulsification techniques, ultrasound time, phaco energy, intraoperative difficulties, management strategies, and intraoperative and postoperative complications.
Results: The mean patient age was 69.3 ± 13.5 years, and primary angle-closure glaucoma accounted for 85.7% of cases. Most eyes underwent phacoemulsification more than 12 months after trabeculectomy (71.5%) and had well-functioning filtering blebs (62.9%). A shallow anterior chamber was present in 54.3% of eyes, Grade III cataract nuclei accounted for 62.9%, and poor or absent pupillary dilation was observed in 31.4%. Quick Chop was the most frequently used phacoemulsification technique (45.7%). Ultrasound time and phaco energy increased with nuclear hardness. The most common intraoperative difficulties were a shallow anterior chamber, poor or absent pupillary dilation, and a hard cataract nucleus. Intraoperative and postoperative complications were generally mild.
Conclusion: Eyes with previous trabeculectomy have several clinical and anatomical characteristics that may increase the technical difficulty of phacoemulsification. Selecting an appropriate phacoemulsification technique according to nuclear hardness and applying suitable intraoperative supportive measures may facilitate surgery and improve surgical safety.