Abstract
Purpose:
To report the long term outcomes and complication rates following trabeculectomy with 5- fluorouracil in a case series of Nigerians.
Methods:
This was a prospective, observational, non-comparative case series. All patients with glaucoma who had trabeculectomy with 5 Fluorouracil at the University College Hospital Nigeria between June 2009 and May 2010 were included. Each patient had a complete ophthalmic evaluation.<br /> The post-operative intraocular pressure (IOP), visual acuity outcomes and post operative complications were assessed. Survival analysis was performed with a minimum follow up 12months. Complete success was defined as intraocular pressure of ≤21mmHg, <18mmHg, 15mmHg without anti-glaucoma medications while qualified success was defined as intraocular pressure of ≤21mmHg, <18mmHg, 15mmHg with anti-glaucoma medications.
Results:
Of the 292 patients who presented with glaucoma (mean age 56.5±16.6, 55.5% males) during this period, a total of 44 eyes of 30 patients (10.3%), aged 10-80 years had trabeculectomy with 5-FU. Their mean age was 48.9±19.6 (median age of 52 years) with a male preponderance (67.7%). The mean presenting intraocular pressure was 31.8±12.2mmHg. The mean deviation on Humphrey visual field was 15.9±9.7 (median of 13dB) with majority of the patients (57.4%) presenting with advanced glaucoma (MD >12dB). At 3 years post operatively 56.8% achieved complete success while 91.9% achieved qualified success at an IOP cut off of ≤21mmHg. At the same time point of 3 years and an IOP cut off of <15mmHg, 48.6% achieved complete success while 59.5% achieved qualified success. At a mean post operative period of 40.8±12.2 months, (range 18-60 months), mean IOP had reduced from a preoperative mean of 31.8±12.2mmHg to 14.6±4.3mmHg (P<0.001). Survival rates at 12 months, 24 months and 36 months were 93.2%, 89.5%, and 88.8% respectively.<br /> Early postoperative hypotony requiring surgical intervention occurred in 3 patients (6.8%). Other complications such as blebitis, hypotonic maculopathy and malignant glaucoma did not occur in this case series.
Conclusions:
Trabeculectomy is effective in the long term in reducing IOP with minimal complications in Nigerians