title: Protection of the conjunctival flap from contact with mitomycin C during tunnel-trabeculectomy.
abstract: OBJECTIVE
  The mid-term appearance of the filtering bleb and surgical outcome following tunnel-trabeculectomy, in which protective measures were carried out to avoid contact between the mitomycin C (MMC) and the conjunctival flap, are presented.
  
  
  METHODS
  In a retrospective study the records of 20 consecutive patients who had undergone tunnel-trabeculectomy >/=24 months earlier, using fornix-based conjunctival flap and MMC (0.4 mg/ml) application were evaluated. Inclusion criteria were patients in whom: (I) the MMC-socked sponge was applied without contact with the conjunctival flap; (II) during MMC washout, a second Weck cell sponge was held anterior to the conjunctival flap, to protect the flap from mitomycin contact during its back-flow. Excluded were five patients who either did not complete 24 months of follow-up (n=4) or underwent an intraocular surgery during that period (n=1).
  
  
  RESULTS
  After 24-32 (26.9+/-2.2) months, the filtering bleb was completely vascularized and thick in 13/15 patients (86.7%), mostly vascularized with some para-limbal thick cysts in one and avascular and cystic in another. Mean intraocular pressure (IOP) dropped from a preoperative level of 25.3+/-7.0 mmHg with 3.5+/-0.9 hypotensive medications to 13.9+/-2.9 mmHg with 0.9+/-1.1 medications (P<0.0001, Wilcoxon test). Of the five excluded patients, the IOP ranged between 10 and 16 mmHg with 0-1 medications at the last examination, 1-15 months postoperatively.
  
  
  CONCLUSIONS
  In this pilot study, an intraoperative protection of the conjunctival flap from mitomycin contact was mostly associated with a vascularized and thick filtering bleb after mid-term follow-up. Further controlled prospective studies are required to confirm these observations.
authors.affiliation: Department of Ophthalmology, Hillel-Yaffe Medical Centre, Hadera, Israel. ophthalmology@hillel-yaffe.health.gov.il
authors.forename: A
authors.initials: A
authors.lastname: Ophir
authors.forename: M
authors.initials: M
authors.lastname: Karatas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001768:Blister / Q000209:etiology; D003228:Conjunctiva / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007429:Intraocular Pressure; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D019384:Nucleic Acid Synthesis Inhibitors / Q000008:administration & dosage*; D010865:Pilot Projects; D011183:Postoperative Complications; D012189:Retrospective Studies; D013524:Surgical Flaps; D007507:Therapeutic Irrigation / Q000379:methods; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D019384:Nucleic Acid Synthesis Inhibitors; D016685:Mitomycin