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. 2017 Feb:174:33-41.
doi: 10.1016/j.ajo.2016.10.006. Epub 2016 Oct 26.

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

Christiane E Al-Haddad  1 , Marwan Abdulaal  2 , Ahmad Al-Moujahed  3 , Ann-Margret Ervin  4 , Karine Ismail  2
Affiliations

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

Christiane E Al-Haddad et al. Am J Ophthalmol. 2017 Feb.

Abstract

Purpose: To compare effectiveness of fornix- and limbal-based conjunctival flaps in trabeculectomy surgery.

Design: Systematic review.

Methods: Setting: CENTRAL, MEDLINE, LILACS, ISRCTN registry, ClinicalTrials.gov, WHO, and ICTRP were searched to identify eligible randomized controlled trials (RCTs).

Study population: RCTs in which benefits and complications of fornix- vs limbal-based trabeculectomy for glaucoma were compared in adult glaucoma patients.

Observation procedure: We followed Cochrane methodology for data extraction.

Main outcome measures: Proportion of failed trabeculectomies at 24 months, defined as the need for repeat surgery or uncontrolled intraocular pressure (IOP) >22 mm Hg, despite topical/systemic medications.

Results: 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 12 months was similar, with ranges of 12.5-15.5 mm Hg and 11.7-15.1 mm Hg, respectively. Mean difference was 0.44 mm Hg (95% CI -0.45 to 1.33) and 0.86 mm Hg (95% CI -0.52 to 2.24) at 12 and 24 months 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 12 months. As far as postoperative complications, an increased risk of shallow anterior chamber was observed in the limbal-based group.

Conclusion: 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.

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Figures

FIGURE 1
FIGURE 1
Selection of trials comparing fornix-based with limbal-based conjunctival trabeculectomy flaps in glaucoma surgery.
FIGURE 2
FIGURE 2
Review authors’ judgment of the risk of bias in the different trials comparing fornix-based with limbal-based conjunctival trabeculectomy flaps in glaucoma surgery.
FIGURE 3
FIGURE 3
Risk of bias summary, presented as percentages, of trials comparing fornix-based with limbal-based conjunctival trabeculectomy flaps in glaucoma surgery.
FIGURE 4
FIGURE 4
Forest plot of trials comparing fornix-based vs limbal-based trabeculectomy surgery with respect to mean intraocular pressure at 12 months (Top) and 24 months (Bottom).
FIGURE 5
FIGURE 5
Forest plot of trials comparing fornix- vs limbal-based trabeculectomy surgery with respect to mean number of antiglaucoma medications at 12 months.
See this image and copyright information in PMC

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