Incidence of endophthalmitis after phacoemulsification cataract surgery: a Meta-analysis.

AIM: To evaluate the overall endophthalmitis incidence and the effectiveness of potential prophylaxis measures following phacoemulsification cataract surgery (PCS). METHODS: The PubMed and Web of Science databases were searched from inception to April 30th, 2021. We included studies that reported on the incidence of endophthalmitis following PCS. The quality of the included studies was critically evaluated with the Newcastle-Ottawa quality assessment scale. The random effect or the fixed-effects model was used to evaluated the pooled incidence based on the heterogeneity. The publication bias was assessed by Egger's linear regression and Begg's rank correlation tests. RESULTS: A total of 39 studies containing 5 878 114 eyes were included and critically appraised in the Meta-analysis. For overall incidence of endophthalmitis after PCS, the Meta-analysis yielded a pooled estimate of 0.092% (95%CI: 0.083%-0.101%). The incidence appeared to decrease with time (before 2000: 0.097%, 95%CI: 0.060%-0.135%; 2000 to 2010: 0.089%, 95%CI: 0.076%-0.101%; after 2010: 0.063%, 95%CI: 0.050%-0.077%). Compared with typical povidone-iodine solution (0.178%, 95%CI: 0.071%-0.285%) and antibiotics subconjunctival injections (0.047%, 95%CI: 0.001%-0.095%), the use of intracameral antibiotics significantly reduced the incidence of endophthalmitis after PCS (0.045%, 95%CI: 0.034%-0.055%, RR: 7.942, 95%CI: 4.510-13.985). CONCLUSION: Due to the advancement of phacoemulsification technology and the widespread use of intracameral antibiotics, the incidence of endophthalmitis following PCS shows a decreasing trend over time. The use of intracameral antibiotics administration will significantly reduce the risk of endophthalmitis.

Dystrophia canthorum in Waardenburg syndrome with a novel MITF mutation.

AIM: To reveal a novel MITF gene mutation in Waardenburg syndrome (WS), which is an autosomal dominant inherited neurogenic disorder that consists of various degrees of sensorineural deafness and pigmentary abnormalities in the eyes, hair and skin. METHODS: The genetic analysis of the Chinese family was conducted by whole-exome sequencing, then the results were confirmed by Sanger sequencing. RESULTS: WS is classified into type I to IV, which are identified by the W index, clinical characteristics and additional features. The MITF gene mostly accounts for WS type II. In this study, a de novo heterozygous mutation in the MITF gene, c.638A>G in exon 7, was identified in the patient diagnosed with WS type I features, as the W index was 2.17 (over 2.10), with dystrophia canthorum, congenital bilateral profound hearing loss, bilateral heterochromia irides, premature greying of the hair, and excessive freckling on the face at birth. She also underwent refractive errors and esotropia, reduced pigmentation of the choroid and visible choroid vessels. The mutation was not found in previous studies or mutation databases. CONCLUSION: The novel mutation in the MITF gene, which altered the protein in amino acids 213 from the glutamic acid to glycine, is the genetic pathological cause for WS features in the patient. Those characteristics of this family revealed a novel genetic heterogeneity of MITF in WS, which expanded the database of MITF mutations and offered a possible in correcting the W index value of WS in distinct ethnicities. Moreover, ocular symptoms should be emphasized in all types of WS patients.

Association of IGF1R polymorphisms (rs1546713) with susceptibility to age-related cataract in a Han Chinese population.

AIM: To explore the susceptible association between the insulin-like growth factor-1 receptor (IGF1R) single nucleotide polymorphism (SNP) and age-related cataract (ARC), and investigate the underlying mechanisms in human lens epithelium (HLE) cells. METHODS: Totally 1190 unrelated participants, comprising 690 ARC patients and 500 healthy individuals in Han Chinese population were recruited and genotyped for target SNP. The χ 2-test was used to detect genotypic distribution between the patient and control groups and the logistic regression was performed to adjust the age and gender. Meanwhile, different biological experimental methods, such as cell counting kit 8 (CCK-8) assay, flow cytometry, quantitative real time polymerase chain reaction (Q-PCR) and Western blot, were used to detect cell viability, cell cycle progression and apoptosis in HLE cells or IGF1R knockdown HLE cells. RESULTS: The rs1546713 in IGF1R gene was identified (P=0.046, OR: 1.606, 95%CI: 1.245-2.071), which shown a significant relevance with ARC risk under the dominant model. The results demonstrated that IGF1R knockdown inhibited cell proliferation by inducing cell cycle arrested at S phase and promoting apoptosis. Mechanistically, the cell cycle blocked at S phase was linked with the alterations of cyclin A, cyclin B, cyclin E and P21. The pro-apoptosis function of IGF1R may related with stimulating the activation of Caspase-3 and altering the expression levels of apoptotic proteins, including Bcl-2, Bax and Caspase-3. CONCLUSION: This study first report that IGF1R polymorphisms may affect susceptibility to ARCs in Han Chinese population and provide new clues to understand the pathogenic mechanism of ARCs. Notably, IGF1R is likely a potential target for ARC prevention and treatment.

The impact of GJA3 SNPs on susceptibility to age-related cataract.

AIM: To determine the association of gap junction protein alpha 3 (GJA3) gene tag single-nucleotide polymorphisms (SNPs) with susceptibility to age-related cataract (ARC). METHODS: In total, 486 ARC patients were matched with 500 healthy controls. All the participants underwent complete ophthalmic examinations. Haplotype-tagging SNPs of GJA3 gene were selected from the HapMap Beijing Han Chinese population. Genomic DNA was extracted from the peripheral blood leukocytes of all the subjects. Under three different genetic models: dominant, recessive, and additive, the association between SNPs and ARC was examined. After adjusting for age and sex, the genetic effects of the GJA3 SNPs were evaluated with logistic regression analysis. RESULTS: Four tag GJA3 SNPs (rs6490519, rs9506430, rs9509053, and rs9552089) were included in the present study. None of the SNPs showed a significant relationship with an altered risk of total ARC under the dominant, recessive, or additive models. In the subgroup analysis, rs9506430 had a significant effect on the formation of a posterior subcapsular cataract (P=0.002, OR: 0.227, 95%CI: 0.088-0.590) under the recessive model. CONCLUSION: Our study indicates that GJA3 variants may influence the development of posterior subcapsular cataracts. Further studies need to be designed to confirm this possibility.

Hydrogen peroxide-induced apoptosis of human lens epithelial cells is inhibited by parthenolide.

AIM: To explore the effect of parthenolide on hydrogen peroxide (H2O2)-induced apoptosis in human lens epithelial (HLE) cells. METHODS: The morphology and number of apoptotic HLE cells were assessed using light microscopy and flow cytometry. Cell viability was tested by MTS assay. In addition, the expression of related proteins was measured by Western blot assay. RESULTS: Apoptosis of HLE cells was induced by 200 µmol/L H2O2, and the viability of these cells was similar to the half maximal inhibitory concentration (IC50), as examined by MTS assay. In addition, cells were treated with either different concentrations (6.25, 12.5, 25 and 50 µmol/L) of parthenolide along with 200 µmol/L H2O2 or only 50 µmol/L parthenolide or 200 µmol/L H2O2 for 24h. Following treatment with higher concentrations of parthenolide (50 µmol/L), fewer HLE cells underwent H2O2-induced apoptosis, and cell viability was increased. Further, Western blot assay showed that the parthenolide treatment reduced the expression of caspase-3 and caspase-9, which are considered core apoptotic proteins, and decreased the levels of phosphorylated nuclear factor-κB (NF-κB), ERK1/2 [a member of the mitogen-activated protein kinase (MAPK) family], and Akt proteins in HLE cells. CONCLUSION: Parthenolide may suppress H2O2-induced apoptosis in HLE cells by interfering with NF-κB, MAPKs, and Akt signaling.

Metabolic syndrome risk factors and dry eye syndrome: a Meta-analysis.

AIM: To explore the relationship between metabolic risk factors and dry eye syndrome (DES). METHODS: Retrieved studies on the association of metabolic syndrome risk factors (hypertension, hyperglycemia, obesity, and hyperlipidemia) and DES were collected from PubMed, Web of Science, and the Cochrane Library in December 2015. Odds ratio (OR) with 95% confidence interval (CI) were pooled to evaluate the final relationship. Subgroup analyses were conducted according to diagnostic criteria of DES. RESULTS: Nine cross-sectional studies and three case-control studies were included in this Meta-analysis. The pooled results showed that people with hypertension, hyperglycemia, and hyperlipidemia had a higher risk of suffering from DES (P<0.05), especially the typical DES symptoms. On the other hand, obesity did not increase the risk of DES. CONCLUSION: The present Meta-analysis suggests that all metabolic risk factors except obesity were risk factors for DES.

Ocular findings in syndromic gingival fibromatosis: a case study and electronic microscopic investigation of lens.

We report a case of syndromic gingival fibromatosis with notable ocular lesions, bilateral congenital cataracts, esotropia, and high myopia of a 21-year-old male patient from China. The patient was diagnosed with gingival fibromatosis based on his massive gingival overgrowth and histological findings that were consistent with gingival fibromatosis through a gingival biopsy. Lens opacity features were presented and phacoemulsificaion with intraocular lens(IOL) implantation was performed to manage the cataracts in both eyes. Transmission electronic microscopy was used to investigate the ultrastructure of the removed lens tissue. We also review the literature on gingival fibromatosis and briefly summarize the ocular manifestations of this rare disease.

[Study of the visual deficits pattern in strabismic and anisometropic amblyopia].

OBJECTIVE: To elucidate the difference in the pathogenesis between strabismic and anisometropic amblyopia. METHODS: It was a case-control study.We used psychophysical methods, including grating acuity, edge contrast sensitivity, contrast sensitivity function tests, and examined the visual functions of 150 cases from 8 to 40-year-old. Then we applied the Origin 8.0 software for statistical analysis of experimental data, we did the correlation analysis between the grating acuity, edge contrast sensitivity and optotype acuity, and the similarity comparison of the contrast sensitivity function curve between the strabismic and anisometropic amblyopia. RESULTS: The grating acuity had a strong correlation with optotype acuity, the correlation value was 0.81. The grating acuity of the strabismic group was roughly 15% lower than the whole abnormal population, for any given level of optotype acuity; the edge contrast threshold had a weak correlation with optotype acuity, the correlation value was 0.24. Anisometropia, for a given level of optotype acuity, had edge contrast thresholds that were 15% higher (worse) than the whole population, while strabismic and strabismic-anisometropia had edge contrast thresholds that are 17% lower (better) than the whole population. The CSF of all amblyopic eyes were reduced in comparison with the non-amblyopic eye of the same person, the peak sensitivity shifted toward to the low spatial frequency region, the CS curve was depressed especially in the middle and high spatial frequencies, there were no significant difference, but at low frequency area(1.0 c/d) there were statistically significant between the two types of amblyopia(t = 2.239, P < 0.05). CONCLUSION: There were differences in the patterns of visual loss between strabismic and anisometropic amblyopic patients.

Chinese family with atypical granular corneal dystrophy type I caused by the typical R555W mutation in TGFBI.

AIM: To investigate the clinical features and genetic defects in four generations of a Chinese family affected with atypical granular corneal dystrophy type I (GCD type I). METHODS: Family history and clinical data were recorded. Genomic DNA samples were obtained from peripheral blood leukocytes of all participated. Exons of the transforming growth factor-ß-induced (TGFBI) gene were directly sequenced after being amplified by polymerase chain reaction (PCR), and multi-point linkage analysis using microsatellite makers flanking the gene was applied to identify the disease-causing mutation. RESULTS: Clinical features were quite variable in patients, some patients only had opacities in the epithelium, and others revealed multiple bilateral circular, discrete, crumb-like opacities mainly in the epithelium, with several in different depths of corneal stroma, and the performance was different bilaterally, even in the same patient. Directly nucleotide sequencing revealed a heterozygous p.R555W mutation in the coding sequence of the TGFBI gene in all affected individuals of the family, but was not found in all unaffected. The maximum logarithm of odds (LOD) score obtained by multi-point analysis was detected at marker locus D5S393 (LOD=2.740; α=1.000). CONCLUSION: Our case presented with clinical futures and the pathogenic mutations in TGFBI gene, the phenotype of the pedigree was quite different from typical GCD type I, so we suggested that this phenotype was a variant of GCD type I. These findings expand the knowledge about GCD type I, and demonstrate that molecular genetic analysis is important to make an accurate diagnosis of patients with variable corneal dystrophies in clinic.

Electron microscopic investigation of anterior lens capsule in an individual with true exfoliation.

AIM: To determine the changes which occur in the anterior capsule in true exfoliation which is a very rare condition. METHODS: The anterior capsule from a 93 year-old patient and 6 other patients with age-related cataract during capsulorhexis was examined via transmission electron microscopy (TEM). RESULTS: TEM revealed apoptosis of lens epithelial cells in both two groups. Moreover, we observed lamellar delamination, granular belts in the anterior capsular zone and loss of the subcapsular epithelium cells in the posterior capsular zone, as well as abnormal fibrils located in the central capsular layer only in the sample from the patient with true exfoliation. CONCLUSION: We suggest that loss of lens epithelial cells and appearance of abnormal fibrils is important in disease developing, and our study supported age-related degeneration is one of causative factors in true exfoliation.

A novel p.R890C mutation in EPHA2 gene associated with progressive childhood posterior cataract in a Chinese family.

AIM: To identify the genetic defect in a Chinese family with bilateral progressive childhood posterior cataract. METHODS: A two-generation family was recruited in this study. Family history and clinical data were recorded. All reported candidate genes associated with congenital posterior cataract were screened by direct DNA sequencing. RESULTS: All affected individuals presented posterior opacities in the lens. Direct sequencing of the candidate genes showed a heterozygous c. 2668C>T variation in EPHA2 gene, which resulted in the replacement of arginine by cysteine at codon 890 (p. R890C). This mutation was found in two affected individuals, but was not observed in 200 normal controls. CONCLUSION: We report a novel mutation (p. R890C) in the EPHA2 receptor tyrosine kinase gene. The finding expands the mutation spectrum of EPHA2 in association with posterior cataract.

Bromfenac sodium 0.1%, fluorometholone 0.1% and dexamethasone 0.1% for control of ocular inflammation and prevention of cystoid macular edema after phacoemulsification.

PURPOSE: To compare bromfenac sodium 0.1%, fluorometholone 0.1% and dexamethasone 0.1% for the control of postoperative inflammation and prevention of cystoid macular edema (CME) after phacoemulsification. METHODS: Patients were randomized to receive bromfenac sodium 0.1% for 1 month (OBS1) or 2 months (OBS2), or fluorometholone 0.1% for 1 month (OFM) or dexamethasone 0.1% for 1 month (ODM). Best-corrected visual acuity, intraocular pressure, endothelial cell density, photon count value and retinal foveal thickness were measured. RESULTS: Mean photon count values were lower in the OBS1 and OBS2 groups compared with the ODM group during the first week. Bromfenac sodium cleared the ocular inflammation more rapidly than fluorometholone and dexamethasone. The foveal thickness was thinner in the second month and the incidence of CME was lower in the OBS1 and OBS2 groups compared with the OFM and ODM groups. CONCLUSION: Bromfenac sodium was more effective and safer than fluorometholone and dexamethasone as an anti-inflammatory, decreasing macular thickness and preventing CME in age-related cataract patients after cataract surgery.

[Would micro-incision phacoemulsification be a new trend of cataract surgery].

Coaxial small-incision phacoemulsification has become the most performed and widely accepted cataract surgery in the world. With the development of phaco technique and advances in surgery skills, ophthalmologists pay more and more attention to micro-incision phacoemulsification. Clinically, there are a number of debates focusing on efficiency and safety of micro-incision phacoemulsification. By analyzing the clinical and laboratory studies at home and abroad, we believe that micro-incision phacoemulsification is safe, efficient and economic. Therefore, it will be a new trend of cataract surgery. In order to support our view and to improve ophthalmologists' understanding about micro-incision phacoemulsification and ultimately strengthen their clinical performance, we primarily introduce the history, features and effects of micro-incision phacoemulsification in this paper.

[Study of clinical application of aberration-free aspheric intraocular lens].

OBJECTIVE: To compare spherical aberration, visual quality and apparent accommodation between pseudophakic patients with an aberration-free aspheric intraocular lens (IOL) and patients with a spherical IOL. METHODS: A prospective study of 130 consecutive cases (132 eyes) was conducted. All cataract patients underwent phacoemulsification were randomized to receive an aberration-free aspheric IOL (Akreos AO, Bausch & Lomb) or a spherical IOL (KS-1, Cannon Staar). Spherical aberration of total eye, best corrected visual acuity (BCVA), near visual acuity (NVA), contrast sensitivity, glare sensitivity and apparent accommodation were measured. Data were analyzed using chi-square test and independent t-test. RESULTS: The mean spherical aberration in eyes with a Tecnis IOL [(0.141 +/- 0.070) microm] was significantly lower than that of eyes with a spherical IOL [(0.210 +/- 0.108) microm; t = 4.365, P = 0.000]. In addition, Akreos AO IOL provided a better contrast sensitivity at 2.5 degrees visual angle (30.62 +/- 12.50 vs. 25.92 +/- 7.36; t = 2.606, P = 0.010), and improved glare sensitivity at 4.0 degrees (31.25 +/- 8.65 vs. 26.70 +/- 7.98; t = 3.116, P = 0.002), 2.5 degrees (26.35 +/- 8.72 vs. 22.43 +/- 7.35; t = 2.772, P = 0.006) and 1.6 degrees (12.35 +/- 4.01 vs. 9.82 +/- 4.12; t = 3.553, P = 0.001) visual angles. The difference of BCVA, NVA and apparent accommodation between these two groups was not statistically significant. CONCLUSION: The present results demonstrated that an aberration-free aspheric IOL, Akreos AO, may reduce the spherical aberration and improve visual performance of pseudophakic eyes and without negative influence on apparent accommodation as compare to conventional spherical IOL.

[Computer construction and analysis of protein models of mutant fibrillin-1 gene in Marfan's syndrome].

OBJECTIVE: Fibrillin-1, the major constituent of extracellular microfibrils, plays an important role in the molecular pathogenesis of Marfan syndrome (MFS, #54700). The aim of this study was to analyze protein models of the mutation of the fibrillin-1 (FBN1) gene on Arg545Cys and Arg1530Cys which have been reported to cause predominant ectopia lentis in Chinese patients. METHODS: We constructed and analyzed the protein models of the mutant FBN1 gene on Arg545Cys and Arg1530Cys. Fibrillin-1 protein structures were predicted by SWISS-MODEL. Models were viewed in Swiss-Pdb Viewer. RESULTS: Computer construction and analysis of protein models of the mutant FBN1 gene revealed that the mutant Arg545Cys FBN1 protein had various changes on protein's secondary structure with an absence of a helix, decreased hydrogen bond distance, different protein surface solvent-accessibility and decreased negative electrostatic potential. The mutant Arg1530Cys FBN1 showed lost of hydrogen bonds, different protein surface solvent-accessibility and increased negative electrostatic potential. CONCLUSIONS: Protein models of the mutant FBN1 gene shows significant alterations on the protein's secondary structure based on computer construction and analysis technology. This study provides further evidence for the important effect of the mutant FBN1 on the pathogenesis of human ectopia lentis.

[Clinical comparison study of aspheric and spherical intraocular lenses].

OBJECTIVE: To compare spherical aberration and visual quality in pseudophakic patients with a modified prolate aspheric intraocular lens (IOL) with patients with a spherical IOL. METHODS: A prospective study of 169 consecutive cases (169 eyes) was conducted. All cataract patients underwent phacoemulsification were randomized to receive an aspheric IOL or a spherical IOL. The following investigations were performed to assess the spherical aberrations of total eye and cornea, best corrected visual acuity (BCVA), near visual acuity (NVA), contrast sensitivity, glare sensitivity and apparent accommodation. RESULTS: The mean spherical aberration in eyes with a Tecnis IOL [(0.024 +/- 0.076) microm] was significantly lower than that of eyes with a spherical IOL [(0.217 +/- 0.137) microm, P = 0.000]. In addition, Tecnis IOL provided improved contrast sensitivity at 4.0 degrees (39.18 +/- 11.94 versus 33.28 +/- 11.84, P = 0.009) and 2.5 degrees (28.30 +/- 12.07 versus 24.50 +/- 8.20, P = 0.033) visual angles, and improved glare sensitivity at 6.3 degrees (30.90 +/- 9.21 versus 27.08 +/- 8.24, P = 0.022), 4.0 degrees (27.09 +/- 8.45 versus 23.30 +/- 6.24, P = 0.008), 2.5 degrees (19.20 +/- 8.71 versus 15.53 +/- 4.37, P = 0.005) and 1.6 degrees (12.08 +/- 4.44 versus 10.04 +/- 4.20, P = 0.014) visual angles. The difference of BCVA, NVA and apparent accommodation between these two groups was not significant. CONCLUSIONS: The present clinical results demonstrated that an aspheric IOL may reduce the spherical aberration and improve visual performance of pseudophakic eyes as compare to conventional spherical IOL.

[Comparison of wavefront aberrations in pseudophakia with three types of intraocular lenses implantation].

OBJECTIVE: We compared wavefront aberration in pseudophakic eyes with 3 types of intraocular lenses (IOLs) implantation in order to obtain an objective evaluation of the optical quality of these pseudophakic eyes. METHODS: This prospective study comprised 76 cataract patients (80 eyes) who had phacoemulsification surgery. The intraocular lenses of AcrySof MA30BM, Hydroview H60M, and Canon Staar, KS-1 were implanted in the patients at the numbers of 26, 27 and 27 eyes in each group respectively. Three months after cataract surgery, aberrations in the eyes were measured in un-dilated pupil using a Hartmann-Shack-type aberrometer (Asclepion-Meditec). The same measurements were done in 26 normal phakic eyes in age-matched persons. Individual Zernike polynomials, coma-like aberration, spherical aberration, the RMS value of total aberrations and total high order aberrations in the each group were compared. RESULTS: The total high order aberrations (the RMS value of 3rd and 4th aberrations) in AcrySof group was higher than Canon Staar group (P = 0.011), and the Z (3, 1) Zernike coefficient in AcrySof group was significant difference compared with Hydroview group (P = 0.038). CONCLUSION: No significant differences in higher-order aberrations among eyes are demonstrated after implantation with 3 types IOLs in un-dilated pupil. The results suggest that there is no difference in the retinal image of pseudophakic eyes with 3 types of IOLs in regular condition.

Computer construction and analysis of protein models of the mutant gammaD-crystallin gene.

BACKGROUND: Gammad-crystallin plays an important role in human cataract formation. Being highly stable, gammaD-crystallin proteins are composed of two domains. In this study we constructed and analyzed protein models of the mutant gammaD-crystallin gene, which caused a special fasciculiform congenital cataract affecting a large Chinese family. METHODS: gammaD-crystallin protein structure was predicted by Swiss-Model software using bovine gammaD-crystallin as a template and Prospect software using human betab2-crystallin as a template. The models were observed with a Swiss-Pdb viewer. RESULTS: The mutant gammaD-crystallin structure predicted by the Swiss-Model software showed that proline23 was an exposed surface residue and P23T change made a decreased hydrogen bond distance between threonine23 and asparagine49. The mutant gammaD-crystallin structure predicted by the Prospect software showed that the P23T change exerted a significant effect on the protein's tertiary structure and yielded hydrogen bonds with aspartic acid21, asparagine24, asparagine49 and serine74. CONCLUSION: The mutant gammaD-crystallin gene has a significant effect on the protein's tertiary structure, supporting that alteration of gamma-crystallin plays an important role in human cataract formation.

[Clinical observation of combined surgery for cataract and glaucoma: phacoemulsification and viscocanalostomy].

OBJECTIVE: To evaluate the therapeutic effects and safety of phacoemulsification-intraocular lens (IOL) implantation combined with viscocanalostomy (V-P) and compared the outcomes of phacoemulsification-IOL implantation combined with trabeculectomy (T-P). METHODS: Combined phacoemulsification with corneal incision, foldable intraocular lens implantation and viscocanalostomy was performed in 30 eyes of 28 cataract patients with primary open-angle glaucoma. RESULTS: Follow-up was performed up to 6 months after surgery. The mean intraocular pressure (IOP) of V-P group was (14.65 +/- 2.70) mm Hg (1 mm Hg = 0.133 kPa) with a mean pressure reduction of 10.33 mm Hg compared with IOP before the operation (P = 0.000). There were no statistical differences of the IOP within two groups during postoperative 1 week, 1 and 6 month (P = 0.661, 0.381, 0.526). Postoperatively, the best corrected visual acuities of V-P group were > or = 0.5 in 18 eyes (follow-up 29 eyes, 62.1%), 20 eyes (28 eyes, 71.4%), 24 eyes (30 eyes, 80.0%) at 1 week, 1 month and 6 months, but no statistical difference with T-P group, (P = 0.621, 0.702, 0.893). Complications of V-P group included: Descemet's membrane puncture 2 eyes (6.7%), Schlemm's tube puncture 2 eyes (6.7%) and IOP spikes 4 eyes (13.3% at 24 hours postoperatively). The V-P group showed a significantly less inflammation, hyphema and choroidal detachment than that in the T-P group. CONCLUSIONS: Phacoemulsification-IOL implantation combined with viscocanalostomy is a safe and efficacious surgery with lower complications.