Fig. 6. ECCE following trabeculectomy. The larger corneal incision associated with ECCE leads to a host of problems that are typically less severe with small incision cataract surgery. With improved phacoemulsification techniques, this type of incision is infrequently encountered. This bleb failed following ECCE, and topical antiglaucoma therapy was restarted. Long-term wound drift; astigmatism, and corneal decompensation are additional visual factors. However, when the nucleus is brunescent and phacoemulsification risky, surgeons with the skill to convert to ECCE through a clear corneal incision are at a significant advantage. This 11-mm free hand incision takes considerable practice and skill to master.