Abstract

Early post-operative leaks following trabeculectomy can lead to hypotony and bleb failure. This video elucidates the art and science of achieving water-tight conjunctival closure with an emphasis on tissue handling to prevent bleb leaks.
When creating a fornix-based peritomy, we recommend leaving a 1mm frill of conjunctiva at the limbus as suturing a wound with the same tissue on either side renders the procedure facile. This method of conjunctival closure combines the benefits of fornix-based flaps (diffuse posterior blebs without ‘ring of steel’) and limbal-based flaps (water-tight closure) in a single technique. Closure of this conjunctival wound is best performed with a continuous, meandering suture which everts the edges ensuring faster healing. An analysis of 160 eyes which underwent trabeculectomy, found that the incidence of leaks was 2.5% with the Frill technique compared to 12.7% with the conventional fornix-based flap (p=0.01).