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Abstract #9992 Published in IGR 5-3
Cystic bleb formation and related complications in limbus- versus fornix-based conjunctival flaps in pediatric and young adult trabeculectomy with mitomycin C
Wells AP; Cordeiro MF; Bunce C; Khaw PTOphthalmology 2003; 110: 2192-2197
OBJECTIVE: Comparison of fornix- and limbus-based conjunctival flaps with respect to cystic bleb-related complications of trabeculectomy with high-dose mitomycin C (MMC) in pediatric and young adult glaucoma. DESIGN: Retrospective nonrandomized comparative interventional case series. PARTICIPANTS: Thirty-seven patients. METHODS: Identification of patients aged <30 years from operating theater records from 1995 and 1996 of the Moorfields Pediatric Glaucoma Service who had trabeculectomy with an MMC concentration of ≥0.4 mg/ml. Over a two-year period, 37 consecutive operations matching these criteria were performed by a single surgeon: 20 with a limbus-based flap and 17 with a fornix-based flap. Except for the conjunctival incision and associated alteration in antimetabolite application and wound closure, the surgical technique was not significantly different between the groups. MAIN OUTCOME MEASURES: Bleb evolution and complications. RESULTS: The age at time of surgery, MMC concentration, history of one or more previous surgeries, and follow-up were similar in the two groups. The risk of cystic bleb formation was greater in the limbus-based flap group (90% in the limbus-based group versus 29% in the fornix-based group; p < 0.001). Late hypotony and bleb-related ocular infection were more common in the limbus-based flap group (p < 0.05) and occurred earlier. There were four episodes of bleb-related infection (20%) in the limbus-based group (three of these (15%) were bleb-related endophthalmitis) and none in the fornix-based group. CONCLUSIONS: In pediatric and young adult trabeculectomy with high doses of MMC, limbus-based flaps may be more likely to develop serious bleb-related complications and may develop these earlier than fornix-based flaps. The higher rates of complications could be attributable to the differences in bleb morphology, with limbus-based flap cases more likely to develop cystic blebs.
Classification:
12.8.10 Woundhealing antifibrosis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
