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.
• Initial treatments include eye drops and laser trabeculoplasty.
• Trabeculectomy is a surgical option when medical treatments fail.

Purpose of the Study:

• To compare the effectiveness of fornix-based versus limbal-based conjunctival flaps in trabeculectomy for adult glaucoma.
• To specifically assess intraocular pressure (IOP) control and complication rates.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) identified through comprehensive database searches.
• Included RCTs compared fornix- versus limbal-based trabeculectomy in adults.
• Excluded studies on children due to differing wound healing and scarring rates.

Main Results:

• Six trials with 361 participants were included; no new eligible studies were found for the update.
• No statistically significant differences in intraocular pressure (IOP) or the number of IOP-lowering medications were observed between fornix- and limbal-based techniques at 12 and 24 months.
• Uncertainty exists regarding failure rates and postoperative complications due to small event numbers and wide confidence intervals.

Conclusions:

• Uncertainty remains regarding the comparative effectiveness of fornix- and limbal-based trabeculectomy due to limited data.
• Both surgical approaches demonstrated similar IOP control and complication profiles.
• No significant impact on long-term trabeculectomy failure rates was identified between the two techniques.