Muhammad Nazim, Yousaf Jamal Mahsood, Sanaullah Jan.
Limbus vs Fornix based Conjuntival Flaps: (Primary Trabeculectomy with MMC).
Ophthalmol Update Jan ;14(3):36-40.

Objective: To compare the efficacy and safety of fornix based with limbus based conjunctival flaps in eyes undergoing primary trabeculectommy with MMC in P0AG& PXG. Design: Randomized control trial. Setting: Department of Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, from 1st April 2011 to1stApril 2012. Methodology: Forty eight eyes of 42 patients were randomized into fornix based (FB) and limbus based (LB) groups. Primary trabeculectomy with MMC augmentation was performed by a single surgeon, on eyes in both the groups diagnosed as having POAG or PXG. MMC was used in a dose of 0.2 mg/dl for 2 minutes. Preoperative and postoperative IOP were noted to together with any adverse events during surgery and during study follow up. SPSS version 17 was used for data analysis. Follow up were done on 1st, 7th day, 30th day and 90th day. Results: Mean presenting IOP with medication was 24mmHg in FB and 27mmHg in LB group. Success rate (IOP <20mmHg without medication) was 100% in FB and 96% in LB and this difference was statistically insignificant (P value < 0.5). In our study the frequency of over-filtration was 58% (average for both groups i.e. 45% for LB and 33% for FB) at 7th post-operative day and then decreased to 20% for each group at 90th day. Difference between two groups regarding control of IOP and safety of the procedure was not statistically significant (P value < 0.5) at final follow up. The frequency of hypotony was higher in FB group as compared to LB group (37 vs. 25%) at 1st post-operative day. At final follow up, the number of eyes with hypotony decreased significantly but it was still 8% noted for FB group compared to 4% for LB (P value < 0.5%). Serious complications like blebitis and endophthalmitis were not noted in any case of our study. Conclusion: There is no statistically significant difference between the two types of MMC augmented primary trabeculectomies in terms of intraocular pressure control. Both surgical techniques are safe and effective to treat glaucoma (POAG and PXG).

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