Trabeculectomy with a scleral wing flap

ABSTRACT

The limbus is a critical area in ocular surgery, particularly glaucoma surgery. Surgical invasion of the external limbus in trabeculectomy weakens the insertion of the conjunctiva and disinserts tenon's capsule in limbus flap, and approximates conjunctival and scleral wounds in fornix-based flaps. This may lead to complications like leakage, buttonholing, Dellen formation, corneal dissection of bleb, thin-walled, cystic, and overhanging blebs. These complications are less likely to occur when the shape of the scleral flap is modified, giving it lateral extensions, "wings", resulting in an incision that reaches the scleral surface behind the sclero-corneal junction, yet can be carried forward into clear cornea for the internal wound lip