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Rebecca Sorenson, Ethan Kutzscher, Andrew L. Sorenson, Ingrid U Scott; Safety and efficacy of incisional glaucoma surgery in Nuevo Progreso, Guatemala. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2679.
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To investigate the safety and efficacy of incisional glaucoma surgery in a developing world setting.
Records were reviewed of patients who underwent incisional glaucoma surgery at Hospital de la Familia in Nuevo Progreso, Guatemala between 1997 and 2003. Of 71 patients who underwent surgery, 69 available charts were reviewed for baseline and postoperative data, including age, gender, glaucoma type, intraocular pressure (IOP), visual acuity, optic nerve appearance, procedure performed, bleb appearance, and perioperative complications.
Fifty-five patients (79.7%) were men and 14 (20.3%) were women. Average age at surgery was 62.6 years (range, 14-89 years). Approximately half of patients presented with primary open angle glaucoma (34, 49.3%), followed by pseudoexfoliation (20, 29.0%), uveitic (3, 4.3%), and traumatic (3, 4.3%) glaucoma. Average presenting IOP was 33.6 mmHg (range, 12-58). The average cup-to-disc ratio was 0.87 (range, 0.3-0.99). Fifty-two patients (75.3%) had a visual acuity of count fingers or worse at presentation. Thirty-five patients (50.7%) received a glaucoma-only procedure, and 34 patients (49.3%) received a combined cataract extraction and glaucoma procedure. Mean follow-up was 26.4 months, with 65.2%, 31.9% and 20.3% of patients followed at 6, 24 and 60 months postoperatively, respectively. Among the 53 patients followed beyond 1 month, the mean IOP at last visit was 14.1 mmHg (range, 0-54). Eleven patients (20.8%) were considered to have failed surgical outcomes based on bleb failure (n=6, 11.3%), postoperative phthisis (n=3, 5.7%), inadequate IOP lowering despite an intact bleb (n=1, 1.9%) and postoperative no light perception vision (n=1, 1.9%). Thirty-nine patients (73.6%) were considered to have successful surgical outcomes based on bleb formation and IOP reduction of at least 20% from baseline.
In this study of patients who underwent incisional glaucoma surgery in Nuevo Progreso, Guatemala, 73.6% achieved an IOP reduction of at least 20%. The overall rate of surgical failure was 20.8%, as compared to reported rates of trabeculectomy and tube shunt failure of approximately 10% per year in the developed world. Our study reflects the challenges of glaucoma management in this setting, including the often advanced stage of disease at presentation and poor return for follow-up, and highlights the need for improved glaucoma management in the developing world.
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