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P.A. Rai, C. Bunce, K. Barton; Fornix versus Limbus-based Conjunctival Flap Trabeculectomy and the Incidence of Bleb-related Infection . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4295.
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Purpose: To explore the influence of conjunctival flap architecture on the incidence of late postoperative bleb-related infection after Mitomycin C (MMC) trabeculectomy Methods: In a previous 600 procedure random sample of 3226 trabeculectomies performed at Moorfields Eye Hospital during a 4 year period (April 1993 - April 1997), the use of MMC was associated with a significantly increased risk of bleb-related infection (p=0.025) Limbus-based conjunctival flap architecture was suspected to influence the risk. Subsequent to 1998, most MMC trabeculectomies were therefore performed via a fornix-based conjunctival flap. In the current study 100 MMC trabeculectomies performed during 1999 were randomly selected for retrospective comparison of infection incidence and conjunctival flap type with our previous 600 trabeculectomy random sample. Results: The cumulative incidence of bleb-related infection in trabeculectomies performed with the use of MMC in 1999 was 2.5% (2 blebitis, no endophthalmitis) after a median follow-up of 38 months compared with 7.4% (4.2% blebitis, 3.2% endophthalmitis) after 44 months in the 1993 - 1997 study. 86.6% of the trabeculectomies performed during 1993-1997, which subsequently developed infection, were performed via limbus-based conjunctival flaps. In comparison, 88.2% of MMC trabeculectomies performed in the 1999 sample were via fornix-based conjunctival flaps. Conclusions: The incidence of late-onset bleb-related infection has reduced at Moorfields Eye Hospital despite a concurrent increase in the use of MMC. This reduction coincides with a change in the type of conjunctival flap used for the majority of cases and suggests that some of the excess risk of bleb-related infection with MMC may be reduced by concurrent use of a fornix-based conjunctival flap.
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