title: Comparative results of combined procedures for glaucoma and cataract: II. Limbus-based versus fornix-based conjunctival flaps.
abstract: OBJECTIVE
  One of the variables to be considered in a combined procedure for glaucoma and cataract is the type of conjunctival flap to be used. The objective of this study was to compare the effects of limbus-based and fornix-based conjunctival flaps on postoperative long-term intraocular pressure (IOP) control and visual acuity after combined trabeculectomy with phacoemulsification.
  
  
  METHODS
  The authors retrospectively reviewed the charts of 189 patients (215 eyes) who underwent combined trabeculectomy with phacoemulsification, posterior chamber intraocular lens (IOL) implantation, and intraoperative mitomycin-C administration and who had a minimum follow-up of 12 months. The results of the limbus-based (151 eyes) versus fornix-based (64 eyes) conjunctival incisions used in these combined procedures were compared.
  
  
  RESULTS
  In the limbus-based conjunctival flap group, 146 eyes (97%) achieved an IOP of less than 20 mm Hg, with or without medication; 62 eyes (97%) of the fornix-based conjunctival flap group (P > .05) achieved this result. A visual acuity of 20/40 or better was noted in 106 eyes (70%) in the limbus-based conjunctival flap group and in 45 eyes (70%) in the fornix-based conjunctival flap group (P > .05) at the last examination. Early wound leakage was observed more frequently in the fornix-based conjunctival flap group (8% vs 1%) (P = .014); however, it was not a serious clinical problem, as only 1 eye required surgical repair. Posterior capsular opacification was found more often in the limbus-based conjunctival flap group (25% vs 14%) (P = .072) and required more frequent laser capsulotomy (22% vs 9%) (P = 0.03).
  
  
  CONCLUSIONS
  Limbus-based and fornix-based conjunctival flaps appear to be comparable with respect to postoperative IOP control and visual acuity after a combined trabeculectomy with phacoemulsification and posterior chamber IOL implantation in cases supplemented by intraoperative mitomycin-C.
authors.affiliation: Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: G
authors.initials: G
authors.lastname: Tezel
authors.forename: A E
authors.initials: AE
authors.lastname: Kolker
authors.forename: M A
authors.initials: MA
authors.lastname: Kass
authors.forename: M B
authors.initials: MB
authors.lastname: Wax
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D002386:Cataract / Q000150:complications* / Q000503:physiopathology; D003228:Conjunctiva / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D007432:Intraoperative Period; D016850:Limbus Corneae / Q000601:surgery*; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage; D009883:Ophthalmic Solutions; D018918:Phacoemulsification; D011183:Postoperative Complications; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000379:methods*; D013536:Suture Techniques; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D000903:Antibiotics, Antineoplastic; D009883:Ophthalmic Solutions; D016685:Mitomycin