International Ophthalmology10:143-147(1987) 9 Martinus Nijhoff/DrW. Junk Publishers, Dordrecht - Printed in ~theNetherlands Lensectomy and vitrectomy in the presence of filtering blebs Gholam A. Peyman ~, Marcia D. Carney & Eve J. Higginbotham Department of Ophthalmology, Eye and Ear lnfitwTary, University of Illinois College of Medicine at Chicago, USA; 11855 W. Taylor St., Chicago, IL 60612, USA (address for offprints) Key words." lensectomy, filtration surgery, Healon R Abstract We describe a technique for preserving a filtering bleb in glaucoma patients undergoing pars plana lensectomy and vitrectomy. It involves making a conjunctival incision away from the filtering site and injecting the anterior chamber and bleb with (hyaluronic acid) Healon R before vitreous surgery is begun. Introduction Surgical Technique A second procedure in an eye that has undergone successful filtering surgery may compromise a fil- tering bleb. Glaucoma specialists advocate the placement of a corneal incision for cataract extrac- tion away from the filtering bleb to allow continued successful filtration. These incisions may be tem- poral or inferior to the limbus or clear corneal cuts anterior to the filtering bleb [2, 5]. Because any conjunctival manipulation may produce inflamma- tion, scarring, and loss of the filtering bleb, we believe that a patient requiring lensectomy and vitrectomy should undergo small perilimbal radial incisions well away from the filtering site to avoid excessive conjunctival manipulation in that area. The integrity of the bleb may also be saved by injecting (hyaluronic acid) Healon R intraocularly. A pars plana lensectomy performed in the pos- terior segment, the stabilization of the subluxated lens away from the cornea using a bimanual tech- nique, and an anterior chamber injection of Healon should reduce corneal endothelial damage in compromised cases. Traction sutures are placed in the upper and lower lids for good exposure of the conjunctiva and the filtering bleb (Fig. 1A). A small (4 to 6 ram), hori- zontal conjunctival incision is made away from the filtering bleb, at approximately the 3 o'clock. An- other conjunctival incision is made at the 9 o'clock position (Fig. 1B), and a complete 180 ~ inferior limbal peritomy is performed. The superior conjunctival incision is extended from the limbus several millimeters posterior to the clinically apparent limits of the filtering bleb (Fig. 1B) for the possible placement of an encircling band, if needed. After the conjunctival recession is completed, a 4-mm cannula is placed temporally (Fig. 1C) to maintain constant infusion pressure. Healon is then injected into the anterior chamber with a 27-gauge needle. By filling the anterior chamber and the filtering bleb with the Healon R before the procedure (Fig. 1D), future recurrent ballooning of the bleb and subsequent conjunctival leaks during vitrectomy are prevented. Sclerotomy sites are then made between the 2 and 3 o'clock positions and 9 and 10 o'clock posi- tions, 3.5 mm posterior to the limbus and well away from the filtering bleb. The posterior segment pha- coemulsifier is placed in one superior sclerotomy