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Fornix-based, limbal-based flaps for trabeculectomy yield similar IOP control, number of bleb failures
A systematic review of randomized controlled trials found similar efficacy of trabeculectomy performed with fornix-based and limbal-based conjunctival flaps with respect to bleb failure and IOP control.
The authors followed Cochrane review methods to select eligible trials comparing benefits and complications of fornix-based vs. limbal-based trabeculectomy as a standalone procedure or in combination with cataract surgery. Six trials met the criteria for inclusion, for a total of 361 participants. Outcomes were evaluated at 12 months in all studies and at 24 months in three studies.
No statistically significant difference was found in regard to bleb failure. Mean IOP at 12 months was comparable, ranging between 12.5 mm Hg and 15.5 mm Hg in the fornix-based group and between 11.7 mm Hg and 15.1 mm Hg in the limbal-based group. Equally comparable was IOP at 24 months in the studies with a longer follow-up. In studies in which mean number of medications and visual acuity outcomes were reported, no difference was found between the groups.
Concerning complications, the only significant difference was a higher risk of shallow anterior chamber after limbal-based trabeculectomy. However, the authors noted that “because of the small numbers of events and total participants, the risk of many reported adverse events was uncertain and those that were found to be statistically significant may have been owing to chance.”
The relatively short follow-up time was also acknowledged as a limitation, and the authors noted that “future trials with longer follow-up could detect differences in surgical outcomes not identified at this time.” – by Michela Cimberle
Disclosure: The authors report no relevant financial disclosures.
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Al-Haddad CE, et al. Am J Ophthalmol. 2017;doi:10.1016/j.ajo.2016.10.006.