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We describe bilateral phacoemulsification and implantation of foldable silicone intraocular lenses in a 25-year-old woman with Alport's syndrome and severe anterior lenticonus. Contrary to previous reports of lens capsule fragility in Alport's syndrome, this patient had relatively tough capsules, as do most patients her age. Apart from the tough capsules and positive pressure, which required the use of a viscoelastic to maintain the anterior chamber, the surgeries were unremarkable. The patient achieved excellent visual and refractive results.

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Deep tunnel scleral pocket incisions were developed to control surgically induced astigmatism following cataract and intraocular lens implantation surgery. A more superficial, shallow scleral pocket incision was developed to reduce the rate of postoperative hyphema. To test its effectiveness, a randomized prospective clinical study was performed. One hundred twenty-nine eyes of 129 patients were randomized: 66 to receive a deep tunnel pocket and 63 to receive the superficial pocket. In both groups the incision was made 3 mm posterior to the limbus. For the deep pocket cases, a blade setting of 0.27 mm was used and the wound was dissected forward toward the entry site, creating a long, deep, narrow tunnel. For the superficial wound cases, a 0.17 mm blade setting was used and the entire wound was dissected to the edge of the anatomic limbus, creating a thin scleral flap. The left side was then fanned out toward the left with the entry site slightly into clear cornea. At one day after surgery, 22 cases (34%) in the deep pocket group and four cases (6%) in the superficial pocket group had hyphemas. The difference in hyphema rates was statistically significant (P less than .001).