title: Two-site phacotrabeculectomy with intraoperative mitomycin-C: fornix- versus limbus-based conjunctival opening in fellow eyes.
abstract: To prospectively compare the influence of fornix-based and limbus-based conjunctival flaps on the final outcome and complications of 2-site phacotrabeculectomy with mitomycin-C in fellow eyes of patients with bilateral open-angle glaucoma (OAG). Glaucoma Unit, Department of Ophthalmology, University of Crete, Crete, Greece.Twenty-two patients with bilateral primary OAG and 8 patients with bilateral exfoliative glaucoma had 2-site phacotrabeculectomy in both eyes. Eyes were randomly assigned to the fornix-based flap or limbus-based flap group by the use of random tables. The intraocular pressure (IOP) decreased significantly in both groups (P <.01); however, there was no statistically significant difference between the groups in the amount of IOP decrease or the number of postoperative antiglaucoma medications after a 1-year follow-up. Faster improvement in visual acuity was observed in the fornix-based group during the first week. The mean time of surgery was 3.5 minutes less in the fornix-based group. An increased incidence of fibrin exudation, pupillary membrane formation, and capsule opacification was found in eyes with exfoliative glaucoma. The early bleb leakage was 3 times more frequent in the fornix-based group. The type of conjunctival flap in a 2-site phacotrabeculectomy did not seem to influence the final outcome. The main advantage of the fornix-based conjunctival flap is the shorter surgical time and the relatively faster improvement in vision postoperatively. The main disadvantage is more frequent early bleb leakage.
authors.affiliation: University of Crete, School of Health Sciences, Division of Medicine, Department of Ophthalmology, Crete, Greece. kozoboli@med.uoc.gr
authors.forename: Vassilios P
authors.initials: VP
authors.lastname: Kozobolis
authors.forename: Charalambos S
authors.initials: CS
authors.lastname: Siganos
authors.forename: Emmanuelle V
authors.initials: EV
authors.lastname: Christodoulakis
authors.forename: Nikolai P
authors.initials: NP
authors.lastname: Lazarov
authors.forename: Maria G
authors.initials: MG
authors.lastname: Koutentaki
authors.forename: Ioannis G
authors.initials: IG
authors.lastname: Pallikaris
mesh_terms: D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D002386:Cataract / Q000150:complications; D003228:Conjunctiva / Q000601:surgery*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure; D007430:Intraoperative Care; D019654:Lens Implantation, Intraocular; D016850:Limbus Corneae / Q000601:surgery*; D008297:Male; D016685:Mitomycin / Q000627:therapeutic use*; D018918:Phacoemulsification / Q000379:methods*; D011446:Prospective Studies; D013524:Surgical Flaps; D013536:Suture Techniques; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D000903:Antibiotics, Antineoplastic; D016685:Mitomycin