Fornix-based versus limbal-based conjunctival flaps in trabeculectomy with mitomycin C in high-risk patients

Kuroda, Utako; Inoue, Toshihiro; Awai-Kasaoka, Nanako; Shobayashi, Kohei; Kojima, Sachi; Tanihara, Hidenobu

doi:10.2147/opth.s61342

Cited by 8 publications

(4 citation statements)

References 17 publications

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“…As reported by Solus et al 25 and Kuroda et al, 36 some reports compared LB and FB groups for surgical success and reported no significant difference. Yokota et al 37 reported in a prospective study a significantly higher surgical failure rate in the FB group than in the LB group of patients with open angle glaucoma.…”

Section: Discussionmentioning

confidence: 89%

Trabeculectomy Tenon Advancement Technique May Reduce Bleb-Related Infections

Mambo

Higashide

Ohkubo³

et al. 2022

Journal of Glaucoma

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Précis: Trabeculectomy using the Tenon advancement technique with a fornix-based (FB) conjunctival flap showed avascular bleb formation less frequently and had a significantly lower risk of developing bleb-related infections than trabeculectomy with a limbus-based conjunctival flap. Purpose: To determine whether the Tenon advancement technique for trabeculectomy with a FB conjunctival flap is effective in preventing bleb-related infections. Materials and Methods: This was a single-center, nonrandomized retrospective cohort study of 998 eyes from 854 patients with glaucoma who underwent trabeculectomy with mitomycin C. Trabeculectomy procedures were categorized into 3 groups: limbus-based (LB, 296 eyes), FB without Tenon advancement (FBTA-, 167 eyes), and FB with Tenon advancement (FBTA+, 535 eyes). The cumulative incidence of bleb-related infections and the rate of surgical success during the 5-year postoperative follow-up period were analyzed using Kaplan–Meier survival analysis and Cox proportional hazards models. Intraocular pressure (IOP) reduction of <20% from baseline or additional glaucoma surgeries was deemed a surgical failure. Surgical success with or without IOP-lowering medications was evaluated according to different IOP criteria. Results: Ten eyes developed bleb-related infections (8 eyes in the LB group and 1 eye in both the FBTA- and FBTA+ groups each). The cumulative probability of bleb-related infections in the LB, FBTA-, and FBTA+ groups was 4.8±1.7% (± standard error), 0.8±0.8%, and 0.3±0.3%, respectively. The FBTA+ group had a significantly lower risk of bleb-related infections than the LB group (hazard ratio, 0.06; 95% confidence interval, 0.01 to 0.39; P=0.009). The FBTA+ group did not have a higher risk of surgical failure. Conclusion: The Tenon advancement technique for trabeculectomy using an FB conjunctival flap may be effective in preventing bleb-related infections without compromising surgical success.

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Section: Discussionmentioning

confidence: 89%

Trabeculectomy Tenon Advancement Technique May Reduce Bleb-Related Infections

Mambo

Higashide

Ohkubo³

et al. 2022

Journal of Glaucoma

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“…Most prior studies have also documented similar IOP control between the limbus-based and fornix-based conjunctival incisions. [ 6 15 16 17 18 19 20 ]…”

Section: Discussionmentioning

confidence: 99%

Merits of conjunctival frill incision in reducing trabeculectomy-induced astigmatism and patient discomfort

Singh

Bhattacharyya

Kumar

2021

Indian Journal of Ophthalmology

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Purpose: To compare results of a novel “conjunctival frill/smile incision” on surgically induced astigmatism (SIA) and patient discomfort vs conventional trabeculectomy in the initial postoperative period. Methods: Sixty trabeculectomy cases were subjected to either conjunctival frill incision, performed 1.5–2.0 mm from the limbus (study group) or conventional fornix-based conjunctival flap (control group). Corneal astigmatism and suture-induced discomfort were assessed by keratometry and a self-devised patient questionnaire, respectively. Results: Both groups generated a “ with the rule ” SIA, which was 1.77 vs 2.42 at 1 week and reduced to 1.27 vs 1.8 in the study vs control group, after removal of sutures – both scleral flap releasable and conjunctival at 1 month. Patient discomfort score revealed enhanced comfort in 37% of patients (study group) vs 17% (control group) during the early postoperative period. After 1 month of surgery, good comfort was regained in all cases. Conclusion: This novel suturing technique results in reduced SIA, patient discomfort during the 1 st month after trabeculectomy.

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“…Several studies have reported that bleb leaks occurred more frequently in fornix-based trabeculectomy but cannot be used for limbal-based trabeculectomy [26, 27]. Meanwhile, other reports found no difference about bleb leak between these two groups [28, 29]. A recent systematic review also reported that there was similar efficacy with respect to IOP control and bleb failure (including bleb leak) in both types of conjunctival flap incisions [30].…”

Section: Discussionmentioning

confidence: 99%

Study of the Efficacy and Safety of Contact Lens Used in Trabeculectomy

Zhang

Yang

2019

Journal of Ophthalmology

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Purpose. To investigate the efficacy and safety of soft bandage contact lens used in trabeculectomy. Methods. This was a prospective, randomized study which enrolled 200 glaucoma patients (200 eyes). Patients were randomized into Group 1, using contact lens after trabeculectomy, and Group 2, without contact lens. The primary outcome measurement was the comparison of success rates at 12 months after surgery. Qualified surgical success was defined as a postoperative intraocular pressure (IOP) value of 6–21 mmHg with or without topical antiglaucoma medication use at the last follow-up visit. Complete success was defined as the IOP between 6 and 21 mmHg without any antiglaucoma medication at the last follow-up visit. Postoperative data included IOP values, best-corrected visual acuity (BCVA), number of antiglaucoma medications, complications related to surgery, and bleb characteristics. Results. There were statistically significant differences between Groups 1 and 2 in mean IOP values at 3, 6, and 12 months after surgery (P<0.05). The 12-month life table rates for qualified surgical success were 94.7% and 86.3% in Groups 1 and 2, respectively (P=0.045). The 12-month life table rates for complete surgical success were 89.6% and 80.0% in Groups 1 and 2, respectively (P=0.042). At 12 months after surgery, the mean numbers of antiglaucoma medications were 0.3 ± 0.4 and 0.5 ± 0.6, respectively. (P=0.001). At the 12-month visit, the maximal bleb area was significantly different between groups (P=0.044), with Group 1 exhibiting a more diffused bleb area. Encysted blebs were observed in 7 (7%) eyes in Group 1 and 17 (17%) eyes in Group 2, with statistically significant differences (P=0.030). The 12-month life table rates for qualified surgical success were 94.7% (91 eyes) and 86.3% (82 eyes) in Groups 1 and 2, respectively (P=0.045). Conclusions. Bandage contact lens is a safe and effective device after fornix-based trabeculectomy.

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Fornix-based versus limbal-based conjunctival flaps in trabeculectomy with mitomycin C in high-risk patients

Cited by 8 publications

References 17 publications

Trabeculectomy Tenon Advancement Technique May Reduce Bleb-Related Infections

Trabeculectomy Tenon Advancement Technique May Reduce Bleb-Related Infections

Merits of conjunctival frill incision in reducing trabeculectomy-induced astigmatism and patient discomfort

Study of the Efficacy and Safety of Contact Lens Used in Trabeculectomy

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