Abstract
Purpose :
This study evaluated complications, adjunct use of anti-metabolites and needling in a large cohort undergoing trabeculectomy surgery in a multi-cultured, government funded, tertiary referral eye unit.
Methods :
Retrospective data collection of consecutive cases requiring trabeculectomy surgery augmented with Mitomycin-C (MMC) was collected over a year. MMC dose was varied depending on the perceived risk of scarring for the individual. Post-operative use of IOP lowering drops, anti-metabolite subconjunctival injections, needling procedures and complications up to a year after surgery was collected. Statistical difference was identified with Kruskal Wallis analysis for ordinal data and χ2 analysis for nominal data.
Results :
The average number of IOP lowering medications at 1-year post surgery was significantly different across the populations (p=0.018) and was higher in the south-Asian population with 0.8 drops followed by the African-Caribbean population with 0.44 and then Caucasian population with 0.17 drops. 37.5% of south-Asian and 34.8% of African-Caribbean population had an office based subconjunctival injection with 5-Fluorouracil (5FU), higher than the 20.6% found in a Caucasian population (p=0.007). Needling rates with 5FU in the Caucasian population was 6.35% which was lower than 17.4 and 16.7% in the African-Caribbean and south-Asian population respectively(p=0.10). Early or late hypotony defined as IOP less than 6 mmHg with either macula folds or choroidal effusions was seen in 13.4% of the Caucasian population and 4.3% of African-Caribbean and south-Asian community combined.
Conclusions :
Modern trabeculectomy with MMC augmentation is a highly successful surgery used to reduce IOP. Our study reveals interesting differences between ethnicities within our Glaucoma community. Ethnicity predicts the risk of aggressive wound healing requiring postoperative interventions and over-drainage with low IOP and potentially sight threatening complications.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.