Combining cataract surgery with glaucoma surgery can be a good fit and we have done that for many decades because cataract surgery alone typically has a pressure-lowering benefit. Many years ago there was a debate about performing phaco with trabeculectomy to determine if two incisions (temporal corneal phaco incision plus superior scleral incision for the trab) were better than one (using a single superior scleral incision for both the phaco and the trab). This surgery, the deep sclerectomy, is thought to have less risk of complications and side effects compared to a trabeculectomy because it does not penetrate into the anterior chamber. The idea behind the deep sclerectomy is to unroof Schlemm’s canal from an ab externo approach and decrease the outflow resistance. Our guest surgeon does a beautiful job with this case and offers some great pearls for you to learn the procedure and incorporate it into your practice. Have you ever performed a deep sclerectomy?
