Trabeculectomy using a fornix-based conjunctival flap and tightly sutured scleral flap

Trabeculectomy is classically and almost universally performed with a limbal-based conjunctival flap. This method has definite theoretic and practical disadvantages compared with a fornix-based conjunctival flap, including (1) poorer visualization and exposure of the area for surgical treatment; (2) a greater chance of button-holing the conjunctival flap; (3) a more anteriorly placed conjunctival bleb; and (4) a higher risk of a thin flap overhanging the cornea. The practical advantages of a fornix-based flap, the surgical results, and the surgical techniques are discussed. Because of its advantages, this method is preferred to the use of a limbus-based conjunctival flap.