Long term results of glaucoma surgery among participants in an east African population survey

Abstract

Aim-To evaluate the long term results of glaucoma surgery among people in East Africa. Methods-Participants in a population based survey of eye disease prevalence were oVered glaucoma surgery using standardised criteria. Either surgical iridectomy or trabeculectomy was carried out as indicated by a medical oYcer or by one of two ophthalmologists. Trabeculectomy methods included releasable sutures and mitomycin C in the majority of eyes. Subjects were examined during the first week and 2 months after surgery. Nearly 3 years later, re-examination was carried out in those who were still resident in the region. Results-Among 46 people who were offered iridectomy, trabeculectomy, or combined cataract extraction/lens implant/ trabeculectomy, 21 people underwent surgery (46%). Of the 21, 19 were reexamined at 3 years (90%), including 16/18 eyes after trabeculectomy. Among these, intraocular pressure (IOP) declined from 29.9 (SD 9.4) mm Hg to 14.7 (5.9) mm Hg, with 16 of 18 eyes (89%) achieving a reduction > 25%. Hypotony maculopathy, late bleb leak, and late endophthalmitis were not detected. Visually significant cataract developed in 5/15 re-examined eyes that underwent trabeculectomy alone (33%), possibly associated with preexisting cataract and diagnosis of angle closure glaucoma, but not with mitomycin C use. Conclusions-Nearly half of those with glaucoma among residents of rural African villages accepted the oVer of surgical therapy. While technical success was achieved at satisfactory levels, the development of cataract must be considered an important issue for application of glaucoma surgical therapy programmes. (Br J Ophthalmol 2000;84:860-864)

Post-operative complication of trabeculectomy in Ibadan, Nigeria: outcome of 1-year follow-up

“…The mean reduction in IOP from 32.2 mm Hg (median ¼ 30.5; SD ¼ 11.4) in the preoperative period to 17.8 mm Hg (median ¼ 17.0; SD ¼ 5.8) at a year follow-up compares with report from other previous studies. 4,[17][18][19] There was no significant difference between the 5-FU and the non-5-FU groups at a year follow-up in term of their mean IOP (P ¼ 0.6). The survival curve between the two groups also failed to demonstrate any added advantage to the use of antimetabolites.…”

What is practical in glaucoma management?

“…[42][43][44][45][46][47][48] In an unmasked randomised trial in a population with advanced glaucoma (93% POAG) in Ghana, a significant beneficial effect for intraoperative subconjunctival 5-FU at a dose of 50 mg/ml for 5 min was reported. 45 Failure (defined as IOP421 mmHg) occurred in 13% for 5-FU compared to 45% for controls, although minimum follow-up was only 3 months (P ¼ 0.01).…”

A review of trabeculectomy in East Asian people—the influence of race

“…Indeed many studies did show benefits of this in terms of lowered IOP, 17,[40][41][42] although there was some evidence to the contrary. 43 However, the consensus of opinion is that use of antimetabolites in blacks has now become the norm, particularly as complications such as hypotony seem to be lower in blacks than in whites.…”