Fornix-based versus limbal-based conjunctival trabeculectomy flaps for glaucoma.

Area of Science:

• Ophthalmology
• Surgical Innovation
• Glaucoma Management

Background:

• Glaucoma is a leading cause of preventable blindness worldwide.
• Trabeculectomy is a common surgical intervention for glaucoma when medical or laser treatments fail.
• Key variations in trabeculectomy involve the type of conjunctival flap used: fornix-based or limbal-based.

Purpose of the Study:

• To compare the effectiveness of fornix- versus limbal-based conjunctival flaps in trabeculectomy for adult glaucoma.
• To specifically assess intraocular pressure (IOP) control and postoperative complications associated with each flap technique.

Main Methods:

• A systematic review of randomized controlled trials (RCTs) was conducted.
• Searches included multiple databases (CENTRAL, MEDLINE, EMBASE, LILACS) and clinical trial registries up to October 2015.
• Included RCTs compared fornix- and limbal-based trabeculectomy in adults; primary outcome was trabeculectomy failure at 24 months, with secondary outcomes including IOP and complications.

Main Results:

• Six RCTs with 361 participants were included.
• No statistically significant difference in mean intraocular pressure (IOP) was found between fornix-based and limbal-based surgeries at 12 and 24 months (moderate quality evidence).
• Rates of trabeculectomy failure and postoperative complications were uncertain due to small event numbers and wide confidence intervals; one trial suggested a trend towards higher failure with limbal-based flaps, but this was not statistically significant.

Conclusions:

• Uncertainty exists regarding the comparative effectiveness of fornix- versus limbal-based trabeculectomy due to limited data.
• Current evidence suggests no significant difference in IOP control or long-term failure rates between the two techniques.
• Further high-quality RCTs are needed to clarify the differences in outcomes and complications.