Fornix-Based Versus Limbal-Based Conjunctival Trabeculectomy Flaps for Glaucoma: Findings From a Cochrane Systematic Review

Abstract

To compare effectiveness of fornix- and limbal-based conjunctival flaps in trabeculectomy surgery. Systematic review. Setting: CENTRAL, MEDLINE, LILACS, ISRCTN registry, ClinicalTrials.gov, WHO, and ICTRP were searched to identify eligible randomized controlled trials (RCTs). RCTs in which benefits and complications of fornix- vs limbal-based trabeculectomy for glaucoma were compared in adult glaucoma patients. We followed Cochrane methodology for data extraction. Proportion of failed trabeculectomies at 24months, defined as the need for repeat surgery or uncontrolled intraocular pressure (IOP) >22mm Hg, despite topical/systemic medications. The review included 6 trials with a total of 361 participants, showing no difference in effectiveness between fornix-based vs limbal-based trabeculectomy surgery, although with a high level of uncertainty owing to low event rates. In the fornix-based and limbal-based surgery, mean IOP at 12months was similar, with ranges of 12.5-15.5mm Hg and 11.7-15.1mm Hg, respectively. Mean difference was 0.44mm Hg (95% CI-0.45 to 1.33) and 0.86mm Hg (95% CI-0.52 to 2.24) at 12 and 24months of follow-up, respectively. Mean number of postoperative glaucoma medications was similar between the 2 groups. Mean difference was 0.02 (95% CI-0.15 to 0.19) at 12months. As far as postoperative complications, an increased risk of shallow anterior chamber was observed in the limbal-based group. Similar efficacy of trabeculectomy surgery with respect to bleb failure or IOP control was observed in both types of conjunctival flap incisions. A significant difference was detected in the risk of postoperative shallow anterior chamber, which was increased in the limbal-based group.