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: PurposeTo prospectively compare the influence of fornix-based and limbus-based conjunctival flaps on the final outcome and complications of 2-site phacotrabeculectomy with mitomycin-C in fellow eyes of patients with bilateral open-angle glaucoma (OAG).: SettingGlaucoma Unit, Department of Ophthalmology, University of Crete, Crete, Greece.: MethodsTwenty-two patients with bilateral primary OAG and 8 patients with bilateral exfoliative glaucoma had 2-site phacotrabeculectomy in both eyes. Eyes were randomly assigned to the fornix-based flap or limbus-based flap group by the use of random tables.: ResultsThe intraocular pressure (IOP) decreased significantly in both groups (P < .01); however, there was no statistically significant difference between the groups in the amount of IOP decrease or the number of postoperative antiglaucoma medications after a 1-year follow-up. Faster improvement in visual acuity was observed in the fornix-based group during the first week. The mean time of surgery was 3.5 minutes less in the fornix-based group. An increased incidence of fibrin exudation, pupillary membrane formation, and capsule opacification was found in eyes with exfoliative glaucoma. The early bleb leakage was 3 times more frequent in the fornix-based group.: ConclusionThe type of conjunctival flap in a 2-site phacotrabeculectomy did not seem to influence the final outcome. The main advantage of the fornix-based conjunctival flap is the shorter surgical time and the relatively faster improvement in vision postoperatively. The main disadvantage is more frequent early bleb leakage. [Copyright &y& Elsevier]

Purpose: Corneal involvement and disturbances of the tear film have been reported in pseudoexfoliation syndrome (PEX). Tear film deficiencies are correlated with changes in corneal sensitivity. The present study aims at evaluating central corneal mechanical sensitivity (CCMS) in PEX., Methods: Patients with unilateral or bilateral PEX findings constituted the study group (SG). Age- and gender-matched patients without PEX in either eye constituted the control group (CG). Patients with conditions affecting corneal sensitivity were excluded. CCMS and central corneal thickness (CCT) were measured (using a Cochet-Bonnet esthesiometer and an ultrasonic pachymeter, respectively). Schirmer (ST) and break-up time (BUT) tests were also performed., Results: The SG included 40 patients (24 male, 60%). The CG included 38 patients (25 male, 65.78%). ST scores were significantly lower in the SG compared with the CG (11.45 +/- 2.52 mm and 14.27 +/- 1.18 mm, respectively, P = 0.04). BUT scores were also significantly lower in the SG compared with the CG (7.64 +/- 2.37 mm and 12.43 +/- 3.14 mm, respectively, P = 0.03). CCMS was significantly (P = 0.02) reduced in the SG compared with CG (4.54 +/- 0.23 cm and 5.73 +/- 0.44 cm, respectively). Differences in CCT between the SG and the CG were not statistically significant., Conclusions: The decrease in CCMS in PEX eyes may be related to decreased BUT and ST scores in PEX, as previously described. However, a direct involvement of sensory nerves may also participate. The reduction in CCMS may have implications for the clinical management of PEX patients.

Purpose: The shape and position of the eyelids affect corneal topography. This study evaluated preoperative and postoperative corneal topography in involutional ectropion of the lower eyelid., Methods: Eighteen patients with unilateral involutional lower eyelid ectropion underwent ophthalmic examinations and corneal topography before surgical correction and at the 6-month postoperative interval. Corneal topographies were evaluated with the Holladay Diagnostic Summary package. The fellow eyes served as controls. Parameters evaluated included the regularity of astigmatism (RA), steep refractive power (SRP), flat refractive power (FRP), and total astigmatism (TA)., Results: Preoperatively, RA was found significantly decreased in the eyes with ectropion compared with the fellow eyes, whereas differences in other parameters were statistically nonsignificant. Postoperatively, RA was significantly increased, whereas SRP was significantly reduced. The percentage of eyes with with-the-rule astigmatism (WTRA) was increased postoperatively, although astigmatic axis changes were not systematic., Conclusions: Postoperative topographic changes may be related to either restoration of symmetry in the upper and lower lid apposition on the cornea or to rearrangement of the tear film. Further research will be required to assess whether corneal topographic findings could be used as an index of the severity of eyelid laxity and to evaluate the effects of topographic changes on corneal and total optical aberrations.