Audit of trabeculectomy at a tertiary referral hospital in East Africa.
OBJECTIVE
To audit medium-term results of trabeculectomy at a tertiary referral unit in east Africa.


METHODS
A retrospective review of the files of all patients who underwent trabeculectomy surgery at our hospital during the year 2001.


RESULTS
One hundred fifty-seven patients were included. Mean age was 61 years (SD = 12). Thirty-one patients (20%) were women; 120 of 145 (83%) eyes had cup/disc ratios of 0.8 or greater preoperatively. Intraoperative 5-fluorouracil (5FU) was used in 57 cases (36%). Mean follow-up was 8 months (0-28, SD = 7). Mean intraocular pressures (IOP) was 25 mm Hg (6-70, SD = 10) preoperatively, 11 mm Hg (0-32, SD = 5) at 2 weeks postoperatively, and 13 mm Hg (0-42, SD = 6) at latest follow-up. One hundred fifteen patients (73%) had intraocular pressure of 15 mm Hg or less at latest follow-up and 141 (90%) had intraocular pressure of 21 mm Hg or less. Twenty (13%) had restarted antiglaucoma medication during the follow-up period. Thirty-seven of 148 (25%) lost 2 lines of Snellen acuity or equivalent between preoperative measurement and latest follow-up. Early postoperative complications (usually leaking bleb or shallow anterior chamber with hypotony) occurred in 18 patients (12%) and this was associated with postoperative loss of 2 or more lines of Snellen acuity (OR = 1.11 95% CI 1.02-1.22, P= 0.02). Patients having had 5FU had lower (t = 3.11, P= 0.02) mean intraocular pressure at 2-month follow-up (12 mm Hg, SD = 5) than those who did not receive it (16 mm Hg, SD = 6) but there was no significant difference at later follow-ups. Men (mean 14 mm Hg, SD = 6) had higher (t = 2.71, P= 0.01) intraocular pressures at latest follow-up than women (mean 11 mm Hg, SD = 3).


CONCLUSIONS
The results of surgery compare well with other reported series. 5FU did not demonstrate significant benefit in terms of intraocular pressure lowering beyond 2 months postoperatively. Early postoperative hypotony should be avoided. The gender difference in intraocular pressure results has not previously been reported and deserves further investigation.
Kabiru
Joy
J
Comprehensive Community Based Rehabilitation for Tanzania Disability Hospital, Dar es Salaam, Tanzania.
Bowman
Richard
R
Wood
Mark
M
Mafwiri
Milka
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D000963:Antimetabolites / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011183:Postoperative Complications; D012017:Referral and Consultation; D012189:Retrospective Studies; D013636:Tanzania; D014129:Trabecular Meshwork / Q000187:drug effects / Q000601:surgery*; D014130:Trabeculectomy / Q000379:methods*; D014792:Visual Acuity / Q000502:physiology
D000959:Antihypertensive Agents; D000963:Antimetabolites; D005472:Fluorouracil