Comparison of fornix versus limbus based combined phacoemulsification and trabeculectomy with mitomycin C

Purpose. To determine if there is a difference in operating time, intraoperative and postoperative complications, and results between limbus vs. fornix based conjunctival flaps in combined phacoemulsification and trabeculectomy with MMC. Methods. A prospective, randomized study of 31 consecutive eyes of 29 patients undergoing combined phacoemulsification and trabeculectomy with MMC performed or supervised by one of us (JSS) was designed to assess visual acuity, intraocular pressure control, and complication rates. 12 eyes had limbus based conjunctival flaps and 19 had fornix based conjunctival flaps. The rest of the operative procedure was the same for both groups. Results. There were no differences in preoperative characteristics of the two groups. The limbus based conjunctival flaps had significantly longer operating times (mean of 97 min. vs. 64 min., p=0.0015) and a higher incidence of buttonholing the conjunctiva (2/12 vs. 0/19, p=0.045). There were no statistically significant differences in the post operative visual acuities and intraocular pressures at 1 day, 1 week, 1 month, 3 months, and 6 months. There was no difference in the rate of vitreous loss (3/12 vs. 3/19). There were no differences in wound leaks (1/12 vs. 3/19), need for suture lysis (7/12 vs. 13/19), need for supplemental 5FU (3/12 vs. 4/19), or trabeculectomy failure rate (2/12 vs. 2/19). Conclusions. There appears to be no difference in postoperative outcome between the limbus and fornix based approaches. There may be an advantage to using a fornix based technique due to shorter operating times and lower conjunctival buttonhole rate.

Duke Scholars

Author Stefanie Gail Schuman Ophthalmology, Vitreoretinal Diseases & Surgery