Fornix-Based Versus Limbal-Based Conjunctival Flaps in Initial Trabeculectomy with Postoperative 5-Fluorouracil

Sayyad, Fathi El; El-Rashood, Adel; Helal, Magdy; Mohammed, Hisham; El-Maghraby, Akef

doi:10.1097/00061198-199904000-00007

Cited by 38 publications

(63 citation statements)

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“…This finding is in agreement with previous studies of trabeculectomy and combined cataract surgery and isolated trabeculectomy that also found no difference between the two methods of conjunctival flap. 5,[8][9][10][11][12][13] Most of these studies addressed unaugmented procedures 5,9,11 or procedures with supplementary subconjunctival 5-fluorouracil injection. 8,13 To the best of our knowledge, only three previous studies have compared fornix-vs limbal-based surgery with MMC augmentation.…”

Section: Discussionmentioning

confidence: 99%

“…5,[8][9][10][11][12][13] Most of these studies addressed unaugmented procedures 5,9,11 or procedures with supplementary subconjunctival 5-fluorouracil injection. 8,13 To the best of our knowledge, only three previous studies have compared fornix-vs limbal-based surgery with MMC augmentation. 10,12,14 One small study by Brinker and Kessing 6 found that unaugmented fornixbased trabeculectomy was statistically superior to limbalbased trabeculectomy with regards to success rate, bleb morphology, and the need for supplementary medical treatment.…”

Section: Discussionmentioning

confidence: 99%

“…With advances in surgical technique, such as the use of adjunctive antifibrotic or antimetabolic agents and the placement of releasable sutures, glaucoma surgery has become a more reliable and predictable undertaking. [1][2][3] Several studies have previously compared the use of fornix vs limbal-based conjunctival flaps in pure trabeculectomy cases, [4][5][6][7][8] cases undergoing concurrent extracapsular cataract extraction surgery, 9 and trabeculectomy combined with phacoemulsification procedures (phacotrabeculectomy). [10][11][12][13] We aim to present outcome data comparing the two flap designs in trabeculectomy procedures carried out under the care of one glaucoma surgeon.…”

Section: Introductionmentioning

confidence: 99%

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Fornix vs limbal-based trabeculectomy with mitomycin C

Alwitry

Patel

King

2004

Eye

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Purpose To compare the effectiveness of limbus-and fornix-based conjunctival flaps in patients undergoing trabeculectomy with mitomycin-C augmentation. Methods A retrospective review of the records of 71 consecutive eyes of 59 patients who underwent trabeculectomy with mitomycin C. All the patients had at least 6 months of follow-up. The first 35 eyes underwent surgery with a limbal-based flap, whereas all subsequent surgeries were by fornix-based procedures. Results No significant difference was detected between the groups with regard to patient demographics, preoperative visual field and intraocular pressure parameters, postoperative intraocular pressures at day 1, months 1, 3, and 6 postoperatively, need for intervention, need for supplementary glaucoma medication, and final visual acuity. There were four cases of overdrainage and hypotony in the limbal-based group, whereas none occurred in the fornix-based group. In all 83% percent of eyes in the limbal-based group achieved intraocular pressures off medication of less than 18 mmHg, whereas 94% of the fornix based group obtained such IOP control. One patient in the limbal-based group developed late postoperative endophthalmitis. Conclusion Trabeculectomy with MMC augmentation is a safe and effective procedure for reduction of IOP and visual rehabilitation whether a fornix-or a limbal-based conjunctival flap is utilised. In this series, there was a greater risk of excessive drainage with subsequent hypotonous complications when surgery was undertaken by a limbal-based procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fornix vs limbal-based trabeculectomy with mitomycin C

Alwitry

Patel

King

2004

Eye

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“…This is similar to others that use the tunnel approach, [15][16][17][18][19][20] but in contrast to studies in which the standard trabeculectomy was used with a fornix-based conjunctival flap. 17,[24][25][26] The difference may be attributed to the tunnel approach, lack of scleral radial incisions and the short and tight closure of the conjunctival flap, as previously discussed. 15 This pilot study provides information regarding the association of protection of the inner wall of the fornixbased conjunctival flap from MMC contact during tunnel-trabeculectomy with a vascularized, thick bleb after 24-32 months of follow-up.…”

Section: Postoperative Complicationsmentioning

confidence: 98%

“…11 In that regard, the filtering bleb tends to become similar or more elevated and cystic following standard trabeculectomy using the limbalbased approach than fornix-based flap one even without the use of antimetabolites; that occurs also following standard trabeculectomy and postoperative subconjunctival 5-fluorouracil (5-FU) injections. [24][25][26] The aforementioned observations following surgery with MMC could be maybe explained as follows:…”

Section: Postoperative Complicationsmentioning

confidence: 99%

Protection of the conjunctival flap from contact with mitomycin C during tunnel-trabeculectomy

Ophir

Karataş

2006

Eye

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Aim The mid-term appearance of the filtering bleb and surgical outcome following tunneltrabeculectomy, 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 Z24 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 ¼ 4) or underwent an intraocular surgery during that period (n ¼ 1). Results After 24-32 (26.972.2) 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 25.377.0 mmHg with 3.570.9 hypotensive medications to 13.972.9 mmHg with 0.971.1 medications (Po0.0001, 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. Conclusion 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.

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Block Suture for Trabeculectomy Using Only 2 Anchors

2008

Arch Ophthalmol

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Fornix-Based Versus Limbal-Based Conjunctival Flaps in Initial Trabeculectomy with Postoperative 5-Fluorouracil

Cited by 38 publications

References 0 publications

Fornix vs limbal-based trabeculectomy with mitomycin C

Fornix vs limbal-based trabeculectomy with mitomycin C

Protection of the conjunctival flap from contact with mitomycin C during tunnel-trabeculectomy

Block Suture for Trabeculectomy Using Only 2 Anchors

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