Role of early trabeculectomy in primary open-angle glaucoma in the developing world

Abstract

Background The lack of prospective data comparing early surgery and medical management in primary open-angle glaucoma (POAG) in the developing world led us to conduct a small randomised controlled clinical trial to evaluate acceptance and effectiveness of early trabeculectomy in these patients. Methods A total of 60 patients with moderately advanced POAG were randomised into three groups (Group IFConventional medical management, Group IIFOption for early trabeculectomy, Group IIIFReceived an educational package about their disease before an option for early trabeculectomy). The patients were followed up for a period of 6 months for visual acuity, intraocular pressures (IOP), and subjective satisfaction. Results The three study groups were statistically similar with respect to mean IOP, demographic, and socio-economic profile. 35% of the patients accepted early surgery when offered a choice between early surgery and medical management in one of the groups. 65% of patients in another group expressed willingness for an early surgery after receiving health education on glaucoma. The mean IOP in the operated eyes was lower than the medically treated eyes at 2 weeks (16.6 vs 23.0 mmHg), 6 months (18.5 vs 22.8 mmHg), and 1-year review (17.9 vs 22.3 mmHg) (Po0.001). No significant difference was seen among the groups with regard to visual acuity and subjective satisfaction. Conclusion There is a reasonable acceptance of early surgery in POAG patients in the developing world and increases on educating patients about their disease. Early surgery offers better IOP control with no long-term subjective adverse effects.

Glaucoma in Africa

“…Primary surgery may be recommended as the treatment of choice, with medical treatment reserved as second line treatment if there is inadequate intraocular pressure control after surgery. 47,[58][59][60][61][62] Although there has been some interest in alternative surgical options for glaucoma in African eyes, 63-65 trabe-culectomy remains the first choice. [66][67][68][69][70] The increased risk of failure of trabeculectomy filtration blebs in African eyes is well documented, and some form of antifibrosis adjunct is recommended.…”

Socioeconomics of long-term glaucoma therapy in India

“…[ 3 4 ] In developed countries, the cost of glaucoma therapy is largely borne by government schemes or medical insurance companies while there are very few studies on the cost of glaucoma therapy in developing countries. [ 5 6 7 8 ] This study was undertaken to evaluate the socioeconomic impact of patients on long-term medical therapy for glaucoma, which included aspects on direct and indirect financial implications, time spent by a patient and caregiver to attend regular reviews in a glaucoma clinic, awareness about the disease and their ability to opt for surgical or laser therapy due to cost implications.…”

Can Adapted Motivational Interviewing Improve Uptake of Surgical or Laser Treatment for Glaucoma in Nigeria: Randomized Controlled Trial

“…Uptake of treatment was higher among participants with higher levels of education, as has been shown previously. 23 However, uptake was not associated with severity of disease, even amongst those at imminent risk of blindness. The reason for this finding is not clear, as it is not uncommon for patients with advanced or end stage disease to lose hope, as highlighted in our earlier study.…”

“…Exacerbating these problems is poor acceptance of and adherence to trabeculectomy, the preferred treatment in Africa, 7,8 as patients experience no immediate visual benefit and are fearful of the procedure. 9 For prevention of blindness in glaucoma there are modifiable factors such as increasing awareness by education, 10,11 and encouraging change in acceptance and adherence to treatment and follow up.…”