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Ke Yang, Ling Jin, Li LI, Aihua Dan, Tingting Chen, Nathan G Congdon; Compliance with Follow-up after Trabeculectomy Surgery in Rural Southern China. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5017.
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Glaucoma is the second-leading cause of blindness in China and globally. In rural areas, surgery is the primary treatment, and patient post-operative follow-up is a crucial determinant of surgical success. We sought to evaluate follow-up rates and their determinants in rural southern China.
Data on follow up at one week, two weeks, and one month after surgery were obtained from medical records. Patients completed questionnaires providing demographic and socioeconomic information, their transportation status, and knowledge and attitudes about glaucoma, glaucoma surgery and importance of follow-up. Linear regression models were used to assess potential predictors of follow-up.
Among 212 patients enrolled and completing questionnaires at 14 rural county-level hospitals in Guangdong and Guangxi Provinces (mean age 60.2 +/- 15.2 years, 54.3% women), the post-operative follow-up rates were 60.8% (129/212),75.9% (161/212) and 26.9% (57/212) at 1 week, 2 weeks and 1 month respectively. Predictors of poor follow-up (treated as a cumulative score, 10 points at 1 week, 7 points at 2 weeks, 5 points at one month) in multiple regression models included having received no formal education (Beta=-3.04, 95% CI -5.56, -0.52, p=0.022), believing follow-up is less important (Beta=-2.64, 95% CI -4.67, -0.61, P=0.015) and lack of an accompanying friend or family member (Beta=-4.94, 95 CI -5.67, -4.21, P<0.001). Age, sex, employment, transportation, and travel distance, time and costs were not significantly associated with follow-up.
Only a quarter of rural patients returned a month after glaucoma surgery, at a time when important post-operative interventions affecting outcome (removal of sutures, adjustment of medications, ocular massage) would still be done. Interventions targeting less-educated patients, providing support for return visits and explaining the importance of follow-up are needed.
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