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M. Kawai, A. Dozaki, R. Kinouchi, S. Ishiko, A. Yoshida; Effect of the Scleral Flap Shape and the Extent of the Conjunctival Incision on Intraocular Pressure Control and Early Postoperative Complications After Fornix-Based Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):178.
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To assess the effect of the scleral flap shape and the extent of conjunctival incision on intraocular pressure (IOP) control and early postoperative complications after fornix-based trabeculectomy.
We studied 59 eyes (59 patients) after trabeculectomy performed by one surgeon (MK) at Asahikawa Medical College. Sixteen eyes (27%) had primary open-angle glaucoma, 11 eyes (19%) primary angle-closure glaucoma, 11 eyes (19%) pseudoexfoliation glaucoma, nine eyes (15%) normal-tension glaucoma, eight eyes (13%) secondary glaucoma, and four eyes (7%) neovascular glaucoma. A triangular scleral flap (4 × 4 mm) with a long 9-mm fornix-based conjunctival flap (TL group) was created in 23 eyes; a square scleral flap (3 × 2.5 mm) with a short 5-mm fornix-based conjunctival flap (SS group) was created in 36 eyes. We retrospectively compared the IOP control and frequency of early postoperative aqueous leaks, hypotony, IOP spikes, and hyphema between the two groups. Kaplan-Meier survival analysis curves were used to study the IOP control. Survival curves for the two groups were compared by the log-rank test. The main criterion for success was a postoperative IOP of 21 mmHg or lower. The chi-square test compared the frequency of early postoperative complications between the groups.
There were no significant differences in age, gender, preoperative IOP, or distribution of glaucoma types between the groups. The cumulative probability of success was 43.5% at 23 months in the TL group and 31.5% at 20 months in the SS group. There were no significant differences in the IOP control between the two groups. Hyphema developed less frequently (5.6%) in the SS group compared with the TL group (26.1%, p=0.047).
A square scleral flap with a short conjunctival incision reduces the frequency of postoperative hyphema in fornix-based trabeculectomy.
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