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Both limbus- and fornix-based trabeculectomy flaps involve tradeoffs, surgeon says
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NEW YORK — The two approaches to flap creation in trabeculectomy each have advantages and disadvantages, and each is effective for different reasons, according to Celso Tello, MD.
Dr. Tello spoke about the tradeoffs involved in using limbus-based or fornix-based flaps at the New Frontiers in Glaucoma meeting, held by Columbia University's College of Physicians and Surgeons. He said that, despite the introduction of a number of nonpenetrating glaucoma surgical procedures in recent years, trabeculectomy is still the most commonly performed procedure for glaucoma.
Dr. Tello said limbus-based flaps offer a more secure and watertight wound closure. However, they are also more technically difficult to perform and require an experienced assistant.
"Healing of the incision can limit posterior flow of aqueous and increase the likelihood of a small, focal and thin-walled bleb," he said.
Fornix-based flaps produce a low-lying and diffuse bleb and are technically easier, with better exposure, he said. They also allow gentler handling of the conjunctiva, preventing damage to the tissue.
"The disadvantage is, it's more difficult to obtain watertight closure," he said.