Abstract
Purpose :
The National Survey of Trabeculectomy (NST) (2001) outlined the expected surgical outcomes for glaucoma filtration surgery in the United Kingdom. We aimed to set a new benchmark and present a living review of Trabeculectomy over 6 years showing ongoing quality improvement in glaucoma surgery.
Methods :
325 consecutive cases of MMC-augmented trabeculectomy from a specialist eye centre were studied in 2009. Success was defined as intraocular pressure(IOP)≤21mmHg at 1 year post-surgery and with a 1/3 reduction, or qualified success if IOP lowering drops were needed to achieve this. Failure was the requirement for further surgery to lower IOP or the development of severe visual loss. A database was created to enable further research and quality improvement. Over the next 6 years,100 new cases were randomly selected from all trabeculectomies performed annually. Outcomes were analyzed and refinements to surgical management implemented each year.
Results :
The 600 cases studied from 2010-15 serve to create a living review of contemporary trabeculectomy surgery. Mean preoperative IOPs were consistently lower than the 25.8mmHg in the NST dataset, and the mean IOP at 1 year after surgery became progressively lower than the NST figure of 12.5mmHg over the 6 years studied (Figure 1). Similarly,over the study period, success rates improved to a level above the NST dataset and failure rates were reduced to a level lower than the current standards (Figure 2). The incidence of early and late complications were markedly lower when compared to the NST dataset: early hypotony 7.5% vs 24.3%, cataract development 8.2% vs 20.3% and endophthalmitis 0% vs 0.2%.
Conclusions :
Trabeculectomy in a specialist eye centre with an ethnically diverse population safely and effectively lowers IOP. This study defines a new improved benchmark for monitoring and improving trabeculectomy outcomes, with new actionable goals for each consecutive year of study enabling continuous improvement in surgical management. Lower pre-operative IOPs highlight the role of earlier surgical intervention in contemporary specialist practice. The greater efficacy in IOP reduction and reduced incidence of post-operative complication are also attributable to the surgical technique (“Moorfields Safer Surgery System” ) used at our centre.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.