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Satoshi Yokota, Yuji Takihara, Masaru Inatani, ; Comparison of Limbus-Based Vs Fornix-Based Trabeculectomy in Surgical Success for Open-Angle Glaucoma Eyes With Prior Ocular Surgery: The Collaborative Bleb-related Infection Incidence and Treatment Study.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3152.
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Prior trabeculectomy or lens extraction are associated with surgical failure of trabeculectomy. Limbus-based trabeculectomy exhibits more avascular bleb, which might contribute to lower postoperative intraocular pressure (IOP) than fornix-based trabeculectomy. We compared the surgical successes of limbus-based and fornix-based trabeculectomy in open-angle glaucoma (OAG) eyes with prior ocular surgery in the Collaborative Bleb-related Infection Incidence and Treatment Study (CBIITS), Japan.
Design: Prospective cohort study. Settings: At 34 clinical centers in Japan. Study Population: Among 1,098 glaucoma eyes in CBIITS, OAG eyes that had undergone previous trabeculectomy and/or lens extraction were analyzed. Interventions: Limbus-based or fornix-based trabeculectomy with mitomycin C were performed. Main outcome measures: IOP, anti-glaucoma medication, and surgical failure (IOP >= 21 mmHg; criterion A, IOP >= 18 mmHg; criterion B, or IOP >= 15 mmHg; criterion C, or < 20% decrease from baseline, reoperation for glaucoma, or loss of light perception vision).
The numbers of the eyes treated with limbus-based (L-based) and fornix-based (F-based) trabeculectomy were 97 and 83, respectively. At 5 years, IOP (mean ± SD) was 12.4 ± 0.7 mmHg and 13.5 ± 0.8 mmHg (P = .29), and the number of anti-glaucoma medications (mean ± SD) was 1.4 ± 1.4 and 1.2 ± 1.2 (P = .47) in the L-based and F-based group, respectively. The cumulative probabilities of failure during 5 years were 44.7% vs 55.2% for criterion A (P = .030), 50.6% vs 65.2% for criterion B (P = .016) and 62.7% vs 72.4% for criterion C (P = .085) in the L-based group vs the F-based group, respectively. F-based incision was significantly associated with surgical failure in Cox-proportional multivariable analysis for criteria A (relative risk; RR = 1.63; P = .036) and B (RR = 1.64; P = .021). The rate of reoperation for glaucoma was 12% vs 8% in the L-based group and the F-based group, respectively (P = .39).
Limbus-based trabeculectomy had higher success probabilities than fornix-based trabeculectomy in OAG eyes that had undergone prior ocular surgery while the two procedures were relatively comparable in IOP reduction, postoperative anti-glaucoma medications and additional glaucoma surgery.
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