title: Interventions to Promote Follow-up After Trabeculectomy Surgery in Rural Southern China: A Randomized Clinical Trial.
abstract: OBJECTIVE
  Follow-up after trabeculectomy surgery is important to surgical success, but little is known about the effect of interventions on improving follow-up in low-resource areas.
  
  
  OBJECTIVE
  To examine whether text message reminders and free eye medications improve follow-up after trabeculectomy in rural southern China.
  
  
  METHODS
  This randomized clinical trial studied 222 consecutive patients undergoing trabeculectomy from October 1, 2014, through November 31, 2015, at 4 rural hospitals in Guangdong and Guangxi Provinces, China. Data from the intention-to-treat population were analyzed.
  
  
  METHODS
  Patients undergoing trabeculectomy were randomized (1:1) to receive text message reminders 3 days before appointments at 1 and 2 weeks and 1 month after surgery and free topical corticosteroid medication (US$5.30) at each visit or to standard follow-up without reminders or free medication.
  
  
  METHODS
  Follow-up at 1 month postoperatively.
  
  
  RESULTS
  Among 222 eligible patients, 13 (5.9%) refused and 209 (94.1%) were enrolled, with 106 (50.7%) randomized to the intervention group (mean [SD] age, 64.4 [12.7] years; 56 women [52.8%]) and 103 (49.3%) to the control group (mean [SD] age, 63.0 [12.7] years; 53 women [51.5%]). A total of 6 patients (2.9%) were unavailable for follow-up. Attendance at 1 month for the intervention group (59 of 102 [57.8%]) was significantly higher than for the control group (34 of 101 [33.7%]) (unadjusted relative risk [RR], 1.72; 95% CI, 1.13-2.63; P = .01). Factors associated with 1-month attendance in multiple regression models included intervention group membership (RR, 1.65; 95% CI, 1.08-2.53; P = .02) and being told to return for suture removal (RR, 1.80; 95% CI, 1.06-3.06; P = .03). One-month attendance among controls not told about suture removal was 3 of 31 (9.7%), whereas it was 44 of 68 (64.7%) among the intervention group with suture removal (unadjusted RR, 6.69; 95% CI, 2.08-21.6; P = .001).
  
  
  CONCLUSIONS
  In this setting, low-cost interventions may significantly improve postoperative follow-up after glaucoma surgery, a potential opportunity for interventions known to improve surgical success.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT02328456.
authors.affiliation: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China2People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Yang
authors.affiliation: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Jin
authors.affiliation: People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.affiliation: People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
authors.forename: Siming
authors.initials: S
authors.lastname: Zeng
authors.affiliation: Yizhou Hospital of Traditional Chinese Medicine, Yizhou, China.
authors.forename: Ruqian
authors.initials: R
authors.lastname: Wei
authors.affiliation: People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
authors.forename: Guirong
authors.initials: G
authors.lastname: Li
authors.affiliation: People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
authors.forename: Pingyi
authors.initials: P
authors.lastname: Man
authors.affiliation: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China4ORBIS International, New York, New York5TREE Centre, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
authors.forename: Nathan
authors.initials: N
authors.lastname: Congdon
mesh_terms: D002681:China / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D019384:Nucleic Acid Synthesis Inhibitors / Q000008:administration & dosage; D009883:Ophthalmic Solutions; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012424:Rural Population; D013997:Time Factors; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D019384:Nucleic Acid Synthesis Inhibitors; D009883:Ophthalmic Solutions; D016685:Mitomycin