A Review of trabeculectomies at a Nigerian teaching hospital

ABSTRACT

Background: Trabeculectomy is the commonest surgical procedure for glaucoma. The outcome of trabeculectomy in the treatment of all types of glaucoma over a 4-year period in a Nigerian population was reviewed. Objective: To determine the surgical rate and effectiveness of trabeculectomy in lowering of intra ocular pressure (IOP) and preservation of visual acuity. Methods: Retrospective review of all trabeculectomies (TEs) done at the Obafemi Awolowo University Teaching Hospital; Ile-Ife between January 1999 and December 2002. The outcome of trabeculectomy was correlated with the biomicroscopic appearance of the filtering bleb; visual acuity and IOP levels. Descriptive statistics were applied to the data. Results: Of the 647 glaucoma patients only fifty-three (8.2); 34 males and 19 females; had trabeculectomy done during the study period. Seventy-two consecutive eyes of these 53 Nigerian patients were operated upon. Majority; 63 (87.5) were in the primary glaucoma group of which 46 63.9) were open angle glaucoma type. Nine eyes (12.5) belonged to the secondary glaucoma group (neovascular; uveitic and traumatic angle recession). Successful control of intra-ocular pressure with medical therapy was recorded only in 13.9f the patients. The mean pre-operative and first post-operative day IOP were 32.5+/- 6.2mmHg and 10.6+/- 2.3mmHg respectively. Mean post-op IOP at 3 months and one year were 14.6+/- 4.2mmHg; and 13.5+/- 5.8mmHg respectively. One year after surgery 34 eyes (61.8) had intraocular pressure (IOP) of 20mm Hg or less without glaucoma medication. Hyphema 11 (15.3) was the commonest post-operative complication documented. Conclusions: Surgical intervention in the management of glaucoma; especially trabeculectomy is not commonly done in this Teaching Hospital. IOP control with medication alone is not adequate in the long term. A significant proportion of the eyes (61.8) had complete success in IOP control following trabeculectomy