Limbus- v fornix-based conjunctival flap in trabeculectomy. A long-term randomized study

Area of Science:

• Ophthalmology
• Surgical Innovation

Background:

• Glaucoma management often requires surgical intervention to reduce intraocular pressure.
• Trabeculectomy is a common filtration surgery for glaucoma.
• Conjunctival flap technique (limbus-based vs. fornix-based) may influence surgical outcomes.

Purpose of the Study:

• To compare the safety and success rates of trabeculectomy using fornix-based versus limbus-based conjunctival flaps.
• To evaluate intraocular pressure control and postoperative complications associated with each flap type.

Main Methods:

• A randomized, prospective study involving patients with uncontrolled primary open-angle glaucoma.
• Trabeculectomy was performed using either a limbus-based (18 eyes) or fornix-based (19 eyes) conjunctival flap.
• Success defined as intraocular pressure ≤ 21 mm Hg, with potential for additional medical therapy.

Main Results:

• Both flap types demonstrated comparable success rates: 94% (17/18) for limbus-based and 89% (17/19) for fornix-based flaps.
• Three eyes in each group required additional medical therapy for pressure control.
• Four eyes in the fornix-based group had early postoperative Seidel test positivity due to aqueous leakage, which resolved spontaneously.

Conclusions:

• Trabeculectomy with fornix-based or limbus-based conjunctival flaps achieves similar efficacy in glaucoma management.
• The fornix-based flap offers advantages in surgical ease, exposure, and closure.
• Fornix-based flaps are a safe and effective alternative for trabeculectomy.