Assessment of Trabeculectomy Operation in a South West England Hospital With Comparison to the National Survey of Trabeculectomy (NST)

Abstract

Assessment Of Trabeculectomy Operation In A South West England Hospital With Comparison To The National Survey Of Trabeculectomy (NST). A retrospective study of 56 consecutive trabeculectomies done in this hospital was performed. The study group had primary open angle glaucoma (64%), pseudo–exfoliation (9%), normal tension glaucoma (9%), pigment dispersion syndrome (2%) and other complicated glaucoma (16%). 27 cases with uveitic glaucoma, history of previous operation, on pilocarpine or adrenaline for more than 6months and young age were considered high–risk". Types of operation, surgical outcome, post–operative complications and waiting times for surgery were compared with the NST. 95% patients in this audit had the operation within 3 months of listing compared to 81.4% patients in the NST (P=0.0049). There was a significantly higher use of intra–operative anti–metabolites (P<0.0001) and bleb intervention (P<0.0001) in this audit. Complication rates were similar between the two though there was a significant lower rate of early postoperative hyphaema compared to NST (P <0.0001). At 1 year follow–up, there was no significant difference in visual loss greater than one Snellen line between the two audits. Qualified and unqualified success defined as postoperative intraocular pressure (IOP) < 2/3 listing IOP with and without anti–glaucoma medication was comparable between this audit and NST. All patients in this audit achieved an unqualified success of IOP<21mmHg compared to 84% patients in NST (P=0.0006) and 71.4% achieved IOP<16mmHg compared to 54.6% in NST (P=0.0064). Trabeculectomies with anti–metabolites had a higher success rate than those without anti–metabolites in both regular (P=0.0002) and high–risk cases (P=0.027). In high–risk cases better results were noted in blebs that underwent some form of resuscitation measure in the postoperative period. There has been significant change in the practice of trabeculectomy over the decade since the National Survey. Overall surgical outcome in this hospital practice is better than the National Survey and increasing numbers of augmented trabeculectomies are being performed with better surgical outcome. Revival measures of bleb in the postoperative period can be vital in achieving better results especially in high–risk cases."