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. 2000 Aug;84(8):860–864. doi: 10.1136/bjo.84.8.860

Long term results of glaucoma surgery among participants in an east African population survey

H Quigley 1, R Buhrmann 1, S West 1, I Isseme 1, M Scudder 1, M Oliva 1
PMCID: PMC1723603  PMID: 10906092

Abstract

AIM—To evaluate the long term results of glaucoma surgery among people in East Africa.
METHODS—Participants in a population based survey of eye disease prevalence were offered glaucoma surgery using standardised criteria. Either surgical iridectomy or trabeculectomy was carried out as indicated by a medical officer or by one of two ophthalmologists. Trabeculectomy methods included releasable sutures and mitomycin C in the majority of eyes. Subjects were examined during the first week and 2 months after surgery. Nearly 3 years later, re-examination was carried out in those who were still resident in the region.
RESULTS—Among 46 people who were offered iridectomy, trabeculectomy, or combined cataract extraction/lens implant/trabeculectomy, 21 people underwent surgery (46%). Of the 21, 19 were re-examined at 3 years (90%), including 16/18 eyes after trabeculectomy. Among these, intraocular pressure (IOP) declined from 29.9 (SD 9.4) mm Hg to 14.7 (5.9) mm Hg, with 16 of 18 eyes (89%) achieving a reduction > 25%. Hypotony maculopathy, late bleb leak, and late endophthalmitis were not detected. Visually significant cataract developed in 5/15 re-examined eyes that underwent trabeculectomy alone (33%), possibly associated with pre-existing cataract and diagnosis of angle closure glaucoma, but not with mitomycin C use.
CONCLUSIONS—Nearly half of those with glaucoma among residents of rural African villages accepted the offer of surgical therapy. While technical success was achieved at satisfactory levels, the development of cataract must be considered an important issue for application of glaucoma surgical therapy programmes.



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Figure 1  .

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Comparison of preoperative and postoperative visual acuity in 17 eyes examined at 3 years after trabeculectomy (from a total of 20 trabeculectomy eyes; excluding one combined cataract/glaucoma case and two trabeculectomy eyes not examined at 3 years). Note five eyes with substantial decreases in acuity. For this figure, the value 0.01 was assigned for the seven eyes whose visual acuity consisted of the perception of hand movements.

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