Fornix vs limbus based flap in phacotrabeculetomy with mitomycin C: prospective study

To compare the efficacy and safety of fornix-based and limbus-based conjunctival flaps of phacotrabeculectomy with mitomycin C in patients with primary open angle glaucoma and cataract.

The study included 16 patients (6 men and 10 women) with primary open angle glaucoma and bilateral cataract. In each patient, phacotrabeculectomy with mitomycin C was performed on both eyes: the eye first operated received a fornix-based conjunctival flap, whereas the fellow eye was assigned to the limbus-based group. We compared preoperative and postoperative visual acuity, intraocular pressure, number of antiglaucoma medications, and postoperative complications between flap-based and limbus-based groups.

There was no difference in the decrease in the mean intraocular pressure between the fornix-based and limbus-based groups after phacotrabeculectomy: from 22.1+/-4.4 mm Hg to 16.2+/-3.4 mm Hg in the fornix-based group, and from 22.4+/-4.5 mm Hg to 15.9+/-3.2 mm Hg in the limbus-based group. The two groups also did not differ in the number of medications received either before or after the surgery. Early bleb leak was observed only in the fornix-based group (2 eyes).

Phacotrabeculectomy with intraoperative mitomycin C was successful in regard to both reduction of intraocular pressure and glaucoma medications. There was no difference in the safety or efficacy of the procedure between groups receiving either fornix- or limbus-based flap, except for the early bleb leak, which was observed only in the fornix flap group.