Edmunds, Lorna Elizabeth Stella; (2002) A national survey of the clinical practice of trabeculectomy in the United Kingdom. Doctoral thesis (M.D), UCL (University College London).

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Abstract

Background and aims: In a climate of increasing demands for quality health care, audit plays a fundamental role. Audit is only meaningful however if the current state of clinical practice is known and if appropriate standards for measuring performance are used. Although trabeculectomy is the most frequently performed glaucoma operation and although a considerable body of literature relating to trabeculectomy outcomes exists, there are no data representative of the national experience of trabeculectomy in the United Kingdom (UK). This survey has three aims: 1. to obtain a representative description of current trabeculectomy practices in the UK 2. to determine the outcomes of trabeculectomy at a national level 3. to examine relationships between study factors and the outcomes of trabeculectomy. Methods: Retrospective survey of all consultant ophthalmologists performing trabeculectomy in the NHS. Each consultant recruited four patients according to study eligibility criteria. Data collected by self-administered questionnaire at baseline, six and twelve months post-trabeculectomy. Non-response and validation studies also performed. Factors characterising the sample and variations in operative technique examined. Main outcome measure: success, defined as final intraocular pressure (IOP) less than two-thirds pre-operative IOP excluding patients on anti-glaucoma medications. Other outcome measures: IOP, visual field stability, early and late complications. Associations between outcomes and variables characterising patient, consultant and operation examined using univariate and multiple regression techniques. Results: 1454 patients recruited, final follow-up questionnaires returned for 1330 (91.5%). No significant non-response, selection or reporting bias. Wide variation in practice patterns with success comparable to other studies, but 66.6% using study definition. Success significantly associated with diabetes, anaesthetic, pre-operative IOP, diagnosis and traction suture. Conclusions: Survey provides representative picture of practice patterns and outcomes of trabeculectomy in the UK. This is a relevant baseline for future comparison and generation of standards for audit. Novel associations between several study factors and outcomes deserve further examination.

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