Outcomes of trabeculectomy among glaucoma patients in Uganda: A 4-year hospital based audit
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
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:
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:
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.
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;
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;
- There are currently no refbacks.