The outcome of Trabeculectomy with Mitomycin C at the Queen Elizabeth Hospital, Barbados

AIM: To evaluate the efficacy of trabeculectomy with mitomycin-c in a predominantly black population. METHOD: The records of 43 eyes with 34 patients (males 15, females 19; age range 22-87 years), who underwent trabeculectomies with mitomycin-c for uncontrolled glaucoma at the Queen Elizabeth Hospital were reviewed. Forty-three eyes (rt eyes 22, Lt eyes 21, unilateral 25, bilateral 9, combined procedure 4) had trabeculectomies. All surgeries were performed by six surgeons between July 1995 and October 1998. The concentration of mitomycin-c varied from 0.2 to 0.5 mg/ml and was applied over 2 to 5 minutes. RESULTS: We evaluated treatment outcome based on the following categories of surgical results for patients with a pre-operative IOP>21mmHg. 1. The operation was considered successful when the IOP was <21mmHg without any anti-glaucoma medications. 2. The operation was a failure when the IOP was raised >21mmHg and required anti-glaucoma medications to control the IOP. The mean preoperative IOP was 26mmHg and the mean postoperative IOP was reduced to 14mmHG. There was failure in 19 eyes where the IOP was raised over >21mmHg and required anti-glaucoma medications or control. Twenty-four eyes were still functional at 18 months with IOPs less than 21mmHg without any anti-glaucoma medications. Visual acuity (VA) in the functional 24 eyes: the VA remained the same in 9 patients and the VA progressively deteriorated in the remaining 15 patients in spite of reduced IOP after mitomycin trabeculectomies. CONCLUSION: The most common cause of failure after trabeculectomy is scarring at the filtration site due to fibrosis or more appropriately normal healing by fibrosis - mitomycin simply delayed the normal healing. Eyes with pseudopakia are at higher risk for failure. Most of the studies in the past were done in the predominantly white population with a short follow-up period. In contrast, all the patients in this study were of African origin and had at least 18 months follow-up, with mean follow-up of 39 months. To our knowledge, this is one of the longest follow-up studies in a predominantly Black population and is the first in the Caribbean. (AU)

Diabetic retinopathy in Barbados: the Barbados eye study

OBJECTIVE: Diabetic retinopathy is an important cause of visual loss in Barbados and the Caribbean region. The Barbados Eye Study (BES) provides the largest source of population based data on diabetic retinopathy in black adults. METHODS: This is a prevalence study of 4,631 participants based on a random sample of the Barbados population aged 40-84 years (84 percent participation). Diabetes was defined as self-reported history of physician diagnosed diabetes and/or glycosylated haemoglobin > 10 percent (2 standard deviations above the population mean of persons without a diabetes history). Retinopathy was assessed by independent gradings of 30 degrees colour stereo fundus photographs of the disk and macula. RESULTS: Diabetes was present in 19.4 percent of blacks (n=4,313), 15.2 percent of mixed black and white; n=184), and 7.5 percent of white/other (n=133) self reported racial groups. Type 1 diabetes was infrequent. In the overall black/mixed study population regardless of diabetes status, the prevalence of retinopathy was 5.9 percent. In the 636 black and mixed participants with diabetes and gradable fundus photographs, the prevalence of retinopathy was 28.5 percent; 19.8 percent had minimum background changes, 7.7 percent had moderate changes and 0.9 percent had severe retinopathy. Clinically significant macular oedema (CSME) was found in 8.6 percent of those with diabetes. CONCLUSION: In the Afro-Caribbean population over 40 years of age, about 1 in 17 persons had retinopathy. Among those with diabetes, 28.5 percent had retinopathy and 8.6 percent had CSME. These results highlight the clinical and public health relevance of diabetic retinopathy in the region (AU)

Treatment of traumatic hyphaema - abstract

Fifty-three (53) patients who sustained hyphaema after blunt trauma were admitted, treated and followed up in the Eye Department, at the Queen Elizabeth Hospital, Barbados. Many forms of treatment are used for patients with traumatic hyphaema. These range from no medication to mydriatics, miotics, tropical and systemic corticosteroids and systemic aminocaproic acid. Several studies in the past suggest that both aminocaproic acid and systemic steroids were successful in reducing the incidence of rebleeding. However, the rate of rebleeding is so variable that controversy exists about the necessity of treatment. In this study, all patients were treated with topical corticosteroids, no mydriatics and strict bed rest. Seven per cent (7.5 percent) of the patients experienced rebleeding; however, rebleeding was not a determining factor related to the final outcome of visual acuity. The adverse reactions of aminocaproic acid and systemic steroids greatly outweigh the benefits of their usefulness in reducing the incidence of rebleeding in our situation. The treatment regime consists of strict bed rest, topical corticosteroids (to treat the masked Iritis) and no mydriatics (to prevent further aggravation of sphincter damage). Raised intraocular pressure is a major concern following traumatic hyphaema and requires early recognition and prompt management (AU)