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Abstract #19987 Published in IGR 9-4
Protection of the conjunctival flap from contact with mitomycin C during tunnel-trabeculectomy
Ophir A; Karatas MEye 2007; 21: 1395-402
AIM: 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. 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.
Dr. A. Ophir, Department of Ophthalmology, Hillel-Yaffe Medical Centre, Hadera, Israel. ophthalmology@hillel-yaffe.health.gov.il
Classification:
12.8.10 Woundhealing antifibrosis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
