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.References
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2. 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 2013. The Lancet. 2015; 386: 743.
3. 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.
4. 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.
5. Heijl A, Peters D, Leske MC, Bengtsson B. Effects of argon laser trabeculoplasty in the early manifest glaucoma trial. Amer J Ophthalmol. 2011; 152: 842-848.
6. 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.
7. Prum BE, Lim MC, Mansberger SL, et al. Primary open-angle glaucoma suspect preferred practice pattern® guidelines. Ophthalmology. 2016; 123: P112-P51.
8. 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. 2013; 16.21-24.
9. 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.
10. 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.
11. 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.
12. Clement CI, Bhartiya S, Shaarawy T. New perspectives on target intraocular pressure. Survey Ophthalmol. 2014; 59: 615-626.
13. Zaidi A. Trabeculectomy: a review and 4-year followup. Br J Ophthalmol. 1980; 64: 436-439.
14. 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.
15. 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.
16. Okimoto S, Kiuchi Y, Akita T, Tanaka J. Using the early postoperative intraocular pressure to predict pressure control after a trabeculectomy. J Glaucoma. 2014; 23: 410-414.
17. 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; 134(4):499-512.
18. 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. 19. 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 Stu
2. 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 2013. The Lancet. 2015; 386: 743.
3. 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.
4. 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.
5. Heijl A, Peters D, Leske MC, Bengtsson B. Effects of argon laser trabeculoplasty in the early manifest glaucoma trial. Amer J Ophthalmol. 2011; 152: 842-848.
6. 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.
7. Prum BE, Lim MC, Mansberger SL, et al. Primary open-angle glaucoma suspect preferred practice pattern® guidelines. Ophthalmology. 2016; 123: P112-P51.
8. 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. 2013; 16.21-24.
9. 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.
10. 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.
11. 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.
12. Clement CI, Bhartiya S, Shaarawy T. New perspectives on target intraocular pressure. Survey Ophthalmol. 2014; 59: 615-626.
13. Zaidi A. Trabeculectomy: a review and 4-year followup. Br J Ophthalmol. 1980; 64: 436-439.
14. 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.
15. 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.
16. Okimoto S, Kiuchi Y, Akita T, Tanaka J. Using the early postoperative intraocular pressure to predict pressure control after a trabeculectomy. J Glaucoma. 2014; 23: 410-414.
17. 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; 134(4):499-512.
18. 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. 19. 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 Stu
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