July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Ten year, single surgeon, series of 'Moorfields safer surgery technique' trabeculectomy, and combined phacotrabeculectomy with IOL: a 'Medisoft' EPR audit from Gloucestershire, UK
Author Affiliations & Notes
  • Andrew Ian McNaught
    Ophthalmology, Gloucestershire Hopsitals NHS Foundation Trust, Cheltenham, Gloucestershire, United Kingdom
    School of Health Professions, Plymouth University, Plymouth, Devon, United Kingdom
  • David Crabb
    Optometry and Visual Science, School of Health Sciences, City, University of London, London, London, United Kingdom
  • Footnotes
    Commercial Relationships   Andrew McNaught, Allergan (R), Novartis (R), Thea (R); David Crabb, Allergan (R), Roche (R), Santen (R)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 466. doi:https://doi.org/
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      Andrew Ian McNaught, David Crabb; Ten year, single surgeon, series of 'Moorfields safer surgery technique' trabeculectomy, and combined phacotrabeculectomy with IOL: a 'Medisoft' EPR audit from Gloucestershire, UK. Invest. Ophthalmol. Vis. Sci. 2018;59(9):466. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : To describe the clinical outcome of trabeculectomies and combined phacotrabeculectomies with IOL done by a single fellowship trained glaucoma specialist, at the same institution, over a period of 10 years, from 2006 to 2016. All procedures were undertaken using the 'Moorfields safer surgery technique'. A full account of the long term effects of this surgery on intra-ocular presure (IOP), supplementary medical treatment, need for further surgery, and visual function is provided.

Methods : 'Medisoft' is the leading ophthalmology EPR in the UK, and was developed by my late colleague, Rob Johnston. We started using 'Medisoft' in Gloucestershire in mid-2005, and since then, all the ophthalmic surgery, and clinic visits, across Gloucestershire, have been recorded, providing a very detailed account of 'real-world' clinical behaviors and outcomes.

We used 'Medisoft' to identify all trabeculectomy and phacotrabeculectomy with IOL surgeries undertaken by the first author between 2006 and 2016. Data were collected to detail the IOP outcomes, surgical complications, and visual function. The aim of the audit was to demonstrate the long-term outcomes of trabeculectomy surgery using a modern, safe, approach to drainage surgery, and also to compare the relative efficacy of trabeculectomy alone, or combined with simultaneous phacoemulsification cataract surgery.

Results : There were 405 trabeculectomies, and 116 combined phacotrabeculectomies with IOL undertaken by the author over the ten years between 2006 and 2016. The mean IOP across time all points, up to 10 years follow-up, was 13mm Hg for trabeculectomies, and 14mm Hg for phacotrabeculectomies and IOL, respectively. Incidence of significant post-operative complications was very low. The visual acuity and visual field outcomes are described in detail, as well as the use of supplemental medical therapy to control IOP post-operatively.

Conclusions : Trabeculectomy or combined phacotrabeculectomy and IOL surgery, using the modern 'Moorfields Safer Surgery Technique' undertaken by a fellowship-trained glaucoma specialist offers effective control of IOP in patients with progressive galucoma. This type of surgery is effective, and also notably safe. Phacotrabeculectomy with IOL was only slightly less effective than trabeculectomy alone in providing long-term IOP control.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.


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