Outcomes of trabeculectomy among glaucoma patients in Uganda: A 4-year hospital based audit

Mbumba FB, Hirnschall N, Arunga S, Kwaga T, Onyango J, Rigal K

Abstract


Objective: To determine the outcomes of trabeculectomy surgery and predictors of post-operative Intra Ocular Pressure (IOP) among glaucoma patients attending Ruharo Eye Centre.
Materials and Methods: In a clinical audit conducted from January to June 2016, we reviewed records of all patients who had undergone trabeculectomy at Ruharo Eye Centre (REC), at least in one eye prior to recruitment. We made phone calls to patients inviting them for a clinical examination. For the patients who turned up, we recorded their Best Corrected Visual Acuity (BCVA), Visual Fields (VFs), Intra Ocular Pressure (IOP), Cup-Disc
Ratio (CDR), and any post-operative complications. We also asked patients about their general satisfaction with both the operation and vision. We did a before and after comparison analysis on several outcome measures using STATA v14. These included: visual acuity, intra ocular pressure, cup disc ratio and visual field. We defined treatment success as a post-operative IOP reduction of 40% from baseline and analyzed for its predictors in a
multivariate regression model.
Results: Sixty-two eyes of 38 patients were included in this study. Median age was 66 years (range 24 to 91 years). Median observation time was 2.8 years (range 0.2-4.6 years). Overall treatment success rate was 95%.
Mean IOP pre-and post-operatively was 32 mmHg (95% CI 29.3-34.7) and 12.9 mmHg (11.7-14.2) respectively, P=0.001; there was no significant worsening of visual acuity and visual field loss. Mean visual acuity Log MAR pre
and post-operatively was 0.58 (95% CI 0.48-0.68) and 0.65 (95% CI 0.52-0.78), P=0.21. Mean visual field defect was 23.4 (95% CI 21.4-25.5) and 22.9 (95% CI 20-9-25.0), P=0.44.
Conclusion: Trabeculectomy in our setting seemed to have a good success rate and provided good IOP control, preservation of vision and visual fields.
Key words: Glaucoma, Trabeculectomy, Intraocular pressure, Uganda


Full Text:

PDF

References


Giangiacomo A, Coleman AL. The epidemiology of

glaucoma. Glaucoma. 2009: 13-21.

Vos T, Barber RM, Bell B, et al. Global, regional,

and national incidence, prevalence, and years lived

with disability for 301 acute and chronic diseases and

injuries in 188 countries, 1990-2013: a systematic

analysis for the Global Burden of Disease Study

The Lancet. 2015; 386: 743.

Kyari F, Abdull MM, Bastawrous A, Gilbert CE, Faal

H. Epidemiology of glaucoma in sub-saharan Africa:

prevalence, incidence and risk factors. Middle East

Afr J Ophthalmol. 2013; 20: 111.

Aminlari AE, Scott IU, Aref AA. Glaucoma drainage

implant surgery–An evidence-based update with

relevance to Sub-Saharan Africa. Middle East Afr J

Ophthalmol. 2013; 20: 126.

Heijl A, Peters D, Leske MC, Bengtsson B. Effects

of argon laser trabeculoplasty in the early manifest

glaucoma trial. Amer J Ophthalmol. 2011; 152:

-848.

Coleman AL, Lum FC, Velentgas P, Su Z, Gliklich

RE, Group RS. Impact of treatment strategies for

open angle glaucoma on intraocular pressure: the

RiGOR study. 2015.

Prum BE, Lim MC, Mansberger SL, et al. Primary

open-angle glaucoma suspect preferred practice

pattern® guidelines. Ophthalmology. 2016; 123:

P112-P51.

Mbumba B, Kagame K, Onyango J, Aliraki L.

Characteristics of glaucoma in black African patients

attending Ruharo Eye Centre, South Western

Uganda. J Ophthalmol East Central Southern Afr.

; 16.21-24.

Arunga S, Bwetsia F, Aliraki L. Diurnal intraocular

pressure fluctuation in black adult primary open angle

glaucoma patients attending Ruharo Eye Centre,

South-Western Uganda. J Ophthalmol East Central

Southern Afr. 2015; 18:8-12.

Nouri-Mahdavi K, Hoffman D, Coleman AL, et

al. Predictive factors for glaucomatous visual field

progression in the Advanced Glaucoma Intervention

Study. Ophthalmology. 2004; 111: 1627-35.

Musch DC, Gillespie BW, Lichter PR, Niziol LM,

Janz NK, Investigators CS. Visual field progression

in the Collaborative Initial Glaucoma Treatment

Study: the impact of treatment and other baseline

factors. Ophthalmology. 2009; 116: 200-7. e1.

Clement CI, Bhartiya S, Shaarawy T. New

perspectives on target intraocular pressure. Survey

Ophthalmol. 2014; 59: 615-626.

Zaidi A. Trabeculectomy: a review and 4-year followup.

Br J Ophthalmol. 1980; 64: 436-439.

Broadway D, Clark A. The Norwich trabeculectomy

study: Long-term outcomes of modern trabeculectomy

with respect to risk factors for filtration failure. J Clin

Exp Ophthalmol. 2014; 5: 2.

Musch DC, Gillespie BW, Niziol LM, Cashwell

LF, Lichter PR, Group CIGTS. Factors associated

with intraocular pressure before and during 9 years

of treatment in the Collaborative Initial Glaucoma

Treatment Study. Ophthalmology. 2008; 115: 927-933.

Okimoto S, Kiuchi Y, Akita T, Tanaka J. Using the

early postoperative intraocular pressure to predict

pressure control after a trabeculectomy. J Glaucoma.

; 23: 410-414.

Gaasterland D, Ederer F, Dally LG, Weiss H, Lichter

P, Wilensky J. The Advanced Glaucoma Intervention

Study (AGIS): 12. Baseline risk factors for sustained

loss of visual field and visual acuity in patients with

advanced glaucoma. Amer J Ophthalmol. 2002;

(4):499-512.

Kotecha A, Spratt A, Bunce C, Garway-Heath DF,

Khaw PT, Viswanathan A. Optic disc and visual field

changes after trabeculectomy. Invest Ophthalmol

Visual Sci. 2009; 50: 4693-99.

Musch DC, Gillespie BW, Niziol LM, Lichter PR,

Varma R, Group CS. Intraocular pressure control and

long-term visual field loss in the Collaborative Initial

Glaucoma Treatment Study. Ophthalmology. 2011;

: 1766-73.


Refbacks

  • There are currently no refbacks.