Combined cataract surgery and goniotomy-assisted 360-degree suture trabeculotomy in a 14-year-old boy

Abstract

Combined cataract and angle surgery potentially eliminates a second surgical setting, further anesthesia, and an additional recovery period, but it can pose intraoperative challenges for the surgeon. The authors demonstrate cataract extraction and 360-degree suture trabeculotomy ab externo with the added challenged of decreased ocular rigidity. Schlemm’s canal was cannulated for 360° with a 6-0 polypropylene suture that was left in place until completion of cataract extraction, limited anterior vitrectomy, and intraocular lens implantation through a scleral tunnel. Transluminal suture was unable to be advanced into the anterior chamber by applying traction on the suture ends. This maneuver, while typically effective in noncombined cases, distorted the scleral tunnel and allowed fluid and viscoelastic device to exit the anterior chamber. Ultimately, trabeculotomy was completed by performing goniotomy of one quadrant under direct visualization, allowing a starting point for transluminal suture to incise the remainder of the trabecular meshwork.