Limbus-based vs fornix-based conjunctival flap in combined glaucoma and cataract surgery with adjunctive mitomycin C.
OBJECTIVE
To determine the efficacy and safety of limbus-based vs fornix-based conjunctival flaps in patients with primary open-angle glaucoma undergoing trabeculectomy combined with phacoemulsification and intraocular lens implantation with adjunctive subconjunctival mitomycin C.


METHODS
In a prospective study, 69 eyes of 69 patients with primary open-angle glaucoma, visually symptomatic cataracts, and no previous incisional ocular surgery were randomly assigned to limbus-based and fornix-based conjunctival flap groups. All patients received trabeculectomy combined with phacoemulsification and posterior chamber lens implantation with 1-minute (0.5 mg/ ml) application of subconjunctival mitomycin C.


RESULTS
The mean intraocular pressures were significantly (P < .05) lower on significantly (P < .05) fewer medications postoperatively at 1 week, 1 month, 3, 6, 9, 12, and 15 to 18 months, and at last follow-up in both groups than they had been preoperatively. However, there were no significant (P > .05) differences in postoperative mean intraocular pressure, mean number of medications, and visual acuity between the two groups at any time interval. Hypotony with wound leak was significantly (P = .019) higher in the limbus-based group. Other postoperative complications were not significantly (P > .05) different between the two groups.


CONCLUSIONS
There was no notable difference in glaucoma control or visual outcome between limbus-based and fornix-based conjunctival flaps in primary trabeculectomy combined with phacoemulsification and lens implantation with adjunctive subconjunctival mitomycin C. The fornix-based flap was as safe as, if not safer than, the limbus-based flap in the glaucoma triple procedure with adjunctive subconjunctival mitomycin C.
Lemon
L C
LC
Kresge Eye Institute, Wayne State University School of Medicine, Detroit, Michigan 48201-1423, USA.
Shin
D H
DH
Kim
C
C
Bendel
R E
RE
Hughes
B A
BA
Juzych
M S
MS
D000368:Aged; D002386:Cataract / Q000150:complications; D017024:Chemotherapy, Adjuvant; D003228:Conjunctiva / Q000601:surgery*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D019654:Lens Implantation, Intraocular; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage*; D009883:Ophthalmic Solutions; D018918:Phacoemulsification; D011446:Prospective Studies; D012449:Safety; D013524:Surgical Flaps; D014130:Trabeculectomy; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
D009883:Ophthalmic Solutions; D016685:Mitomycin