Fig. 7. Phacotrabeculectomy adjacent to a failed filter in cataractous eye. The ability to combine small-incision cataract extraction with trabeculectomy all through the same incision adjacent to the failed filter allows the surgeon to work in a familiar superior area. Avoiding incisions into the existing bleb decreases conjunctival buttonholes, hypotony, operating room time, and subconjunctival bleeding. A. Appearance of failed bleb with exposure of superior temporal quadrant gained with a corneal traction suture. B. Prepare a limbus-based conjunctival flap and a scleral flap. C. This bleb is at high risk to fail again justifying the need for MMC, 0.2 mg/cc applied on a pledget for 4 minutes. D. Insert the keratome and perform phacotrabeculectomy in the usual fashion.