Combined cataract and trabeculectomy surgery for advanced glaucoma in East Africa; visual and intra-ocular pressure outcomes

• Published in: Eye (London) Vol. 24; no. 4; pp. 573 - 577
• Main Authors: Bowman, R J C, Hay, A, Wood, M L, Murdoch, I E
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-04-2010; Nature Publishing Group
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; clinical-study; Female; Follow-Up Studies; Glaucoma; Glaucoma - physiopathology; Glaucoma - surgery; Glaucoma and intraocular pressure; Humans; Intraocular Pressure; Laboratory Medicine; Lens diseases; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Miscellaneous; Ophthalmology; Phacoemulsification; Pharmaceutical Sciences/Technology; Retrospective Studies; Surgery; Surgical Oncology; Trabeculectomy - methods; Visual Acuity; Young Adult; East Africa; Africa; cataract; glaucoma; phacotrabeculectomy; Africa; Glaucoma; Trabeculectomy; Protozoa; Cataract; Prognosis; Ocular; Pressure; Eye; Eye disease; Lens disease; Treatment; Combined surgery; Glaucoma (eye); Evolution; Advanced stage; Ciliata; Ophthalmology; Anterior segment disease
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/eye.2009.132

Aim
To investigate visual and intra-ocular pressure (IOP) outcomes of combined cataract and glaucoma surgery at a high-volume centre in East Africa carried out over a 1-year period (2006).
Methods
A retrospective analysis of patient records.
Results
A total of 163 patients were identified. Mean age was 67 years (SD 11, range 21–86 years) and 113 (69%) were men. Presenting visual acuity in the operated eye was 6/60 or worse in 135/163 (93%) and was <3/60 in 76 of 163 (47%) patients. Mean presenting IOP was 28 mm Hg (SD 9, range 12–60). Pre-operative cup disc ratios were 0.8 or worse in 131 of 163 (85%) patients. Phacotrabeculectomy (PT) was carried out in 130 (80%) cases, small incision cataract surgery trabeculectomy (SICST) in 10 (6.1%) cases, and extra-capsular cataract extraction trabeculectomy (ECCET) in 23 (14.1%) cases. In all, 107 (66%) attended for follow-up (mean interval 104 days, range: 6–390 years, SD 88) and at follow-up 75 (70%) patients had improved visual acuity pre-operatively. Pre-operative cup disc ratio of 0.9 or greater predicted failure to improve VA at follow-up (OR 4.0 95% confidence interval (CI) 1.30–12.1). Fifty-nine (62% (95%CI 52–71%)) patients had follow-up IOPs of 6–15 mm Hg and 82 (85% (95% CI 78–92%)) had follow-up IOPs of 6–20 mm Hg.
Conclusion
Combined surgery produces visual benefit for most patients with similar pressure control to pure trabeculectomy and is therefore a useful option in practises where follow-up may be doubtful.