ReGAE 7: long-term outcomes of augmented trabeculectomy with mitomycin C in African Caribbean patients

Authors

  • Peter Shah FRCOphth,

    Corresponding author
    1. University Hospitals Birmingham NHS Foundation Trust
    2. Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham
    3. Centre for Health and Social Care Improvement, School of Health and Wellbeing, University of Wolverhampton, Wolverhampton
    4. National Institute for Health Research Biomedical Research Centre, UCL Partners/ Moorfields Eye Hospital NHS Foundation Trust
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  • Pavi Agrawal MRCOphth,

    1. University Hospitals Birmingham NHS Foundation Trust
    2. Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham
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  • Peng T Khaw PhD FRCOphth,

    1. National Institute for Health Research Biomedical Research Centre, UCL Partners/ Moorfields Eye Hospital NHS Foundation Trust
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  • Fariha Shafi MA,

    1. University Hospitals Birmingham NHS Foundation Trust
    2. Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham
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  • Freda Sii MBBS

    1. University Hospitals Birmingham NHS Foundation Trust
    2. Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham
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  • Conflict/competing interest: No stated conflict of interest.

  • Funding sources: No specific funding.

  • REC Reference Number: 10/H1203/4.

Professor Peter Shah, University Hospital Birmingham, Selly Oak Hospital, Raddlebarn Road, Birmingham B29 6JD, UK. Email: peter.shah@uhb.nhs.uk

Abstract

Background:  To evaluate long-term outcomes and complication rates following trabeculectomy with mitomycin C in a case series of African Caribbean patients.

Design:  A prospective, observational and non-comparative case series.

Participants:  Forty-seven consecutive African Caribbean patients (47 eyes) with glaucoma.

Methods:  All patients underwent augmented trabeculectomy with mitomycin C for uncontrolled intraocular pressure (IOP). Survival analysis was performed with a minimum of 12 months' follow up.

Main Outcome Measures:  Surgical success was based upon IOP reduction to ≤21 mmHg, ≤18 mmHg and ≤15 mmHg without glaucoma medication (complete); or IOP reduction to ≤21 mmHg, ≤18 mmHg and ≤15 mmHg with or without glaucoma medication (qualified).

Results:  The mean follow-up period was 48.6 months. At 3 years post-trabeculectomy 92.6% achieved a qualified success and 59.3% a complete success for an IOP ≤21 mmHg. At final follow up the mean IOP reduced from 33.7 mmHg to 13.1 mmHg (P < 0.0001). Survival rates were 96%, 90% and 86% at 12, 24 and 36 months, respectively, with a mean survival time of 97.4 months (95% confidence interval, 86.0–108.8) for an IOP ≤21 mmHg. Early postoperative hypotony requiring surgical intervention occurred in four (8.5%) patients. There were no cases of blebitis, endophthalmitis, suprachoroidal haemorrhage, malignant glaucoma or hypotony maculopathy.

Conclusions:  Good long-term stable IOP can be achieved with low complication rates and high success rates amongst African Caribbean patients following trabeculectomy with mitomycin C. A proactive postoperative management regime is needed to ensure trabeculectomy survival in high-risk populations.

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