The Clinical profile and operative outcomes of adult patients undergoing glaucoma surgery at Queen Elizabeth Central Hospital, Blantyre, Malawi

Abstract

Objective: This study was conducted to describe the characteristics and operative outcomes of adult patients undergoing glaucoma surgery at the Eye Department at Queen Elizabeth Central Hospital, Blantyre, Malawi.
Methods: This was a retrospective case series review of medical records. Case files of adult patients who underwent glaucoma surgeries between March 2019 and February 2020 were reviewed. The procedures of interest were trabeculectomy, Ahmed glaucoma valve surgery, and combined trabeculectomy and small incision cataract surgery. The primary outcome measure was the percentage post-Operative Intraocular Pressure (IOP) drop with a reduction of 30% or greater classified as a successful surgery. The pre-operative and post-operative median IOPs were compared using Wilcoxon’s sign-ranked test. In addition, the Kruskal-Wallis test was used to compare the median IOPs of the three procedures. A multivariate binary logistic regression model was used to
analyse possible factors associated with the surgical outcome.
Results: Sixty-two patient records fitting the inclusion criteria were found, reviewed, and analysed. There was a male to female ratio of 2:1. Two-thirds of the study population presented with blindness in one eye, and three quarters had advanced glaucoma. Successful IOP reduction was achieved in 70.9% and 91.9% of eyes on days one and seven post-operation, respectively. There were no statistically significant pre-operative or postoperative factors associated with the outcome identified in this study.
Conclusions: This study shows advanced disease, advanced age and male preponderance among the patients undergoing glaucoma surgery at a tertiary level eye unit in Malawi. Furthermore, the glaucoma surgeries achieved high rates of successful IOP lowering effects comparable to rates from similar studies in other parts of Africa.