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Glaucoma Surgery Outcome in Rwanda

De Smedt, SK; Fonteyne, YS; Muragijimana, F; Palmer, K; Murdoch, I; (2016) Glaucoma Surgery Outcome in Rwanda. Journal of Glaucoma , 25 (8) pp. 698-703. 10.1097/IJG.0000000000000419. Green open access

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Abstract

PURPOSE: To assess long-term intraocular pressure (IOP) outcome after adult trabeculectomy surgery in Central Africa. PATIENTS AND METHODS: All adult glaucoma patients who underwent trabeculectomy surgery in the Kabgayi Eye Unit, Rwanda between August 2003 and March 2008 were invited for a follow-up visit. Surgical and clinical data were collected from medical records. At the study visit, best-corrected visual acuity was measured and Goldmann applanation tonometry and biomicroscopy were done. Good IOP outcome was defined as both an IOP<21 mm Hg and achieving ≥30% reduction from the preoperative IOP. Considering first operated eyes, univariate and multivariate logistic regression was used to investigate risk factors for failure. RESULTS: Of 163 individuals operated 3 had died, 118 (74%) participated. Preoperatively, the mean IOP was 31 mm Hg (SD=11; range, 12 to 60). At the time of the follow-up study visit the mean postoperative IOP was 13 mm Hg (SD=5; range, 4 to 35). Good IOP outcome was achieved in 132 eyes (84%). Univariate analysis suggested a protective effect against failure of use of antimetabolites [odds ratio (OR)=0.39; 95% confidence interval (CI), 0.14-1.11; P=0.07] and a decrease in success with length of follow-up (OR=3.57; 95% CI, 1.09-12.50; P=0.03). The latter remained borderline significant with multivariate analysis. Seven eyes went from previously better vision (at least hand movements) down to perception of light or no perception of light after trabeculectomy. Particularly a flat anterior chamber in the first postoperative week (OR=0.07; 95% CI, 0.01-0.49; P<0.001) and late hypotony (OR=0.04; 95% CI, 0.002-0.99; P=0.004) were significant risk factors for severe visual loss. CONCLUSIONS: Trabeculectomy with antimetabolites is one of the best available options for glaucoma management in Africa. However, the IOP control reduced at a follow-up duration beyond 2 years, highlighting the importance of regular long-term follow-up.

Type: Article
Title: Glaucoma Surgery Outcome in Rwanda
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/IJG.0000000000000419
Publisher version: http://dx.doi.org/10.1097/IJG.0000000000000419
Language: English
Additional information: © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: Glaucoma surgery, Africa, outcome, antimetabolites, follow-up
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
URI: https://discovery.ucl.ac.uk/id/eprint/1513275
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