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Abstract #6532 Published in IGR 3-2
The national survey of trabeculectomy. II. Variations in operative technique and outcome
Edmunds B; Thompson JR; Salmon JF; Wormald RPEye 2001; 15: 441-448
PURPOSE: There ia a considerable body of literature relating to trabeculectomy; however, there are no data representative of the national experience of trabeculectomy in the UK. The Department of Health funded a national survey of trabeculectomy in the National Health Service (NHS). In this paper, the authors report variations in surgical technique and the national success rate of trabeculectomy. METHODS: A cross-sectional survey was carried out of consultant ophthalmologists performing trabeculectomy in the NHS. Participants recruited their four most recent consecutive first-time trabeculectomy cases according to study eligibility criteria and data were collected by self-administered questionnaire. Follow-up: one year post-trabeculectomy. Main outcome measure of success: final intraocular pressure (IOP) less than two-thirds the preoperative IOP. Secondary outcome measures of success: final IOP less than 21 mmHg and visual field stability. Success was further defined as unqualified (excluding patients on anti-glaucoma medications at final follow-up) or qualified (including patients on anti-glaucoma medications at final follow-up). The relationship between variables characterizing consultants' practice and main outcome measure was examined by chi-square test. RESULTS: Clinical outcome data were available for 1240 (85.3%) cases. There were wide variations in operative technique. The mean postoperative IOP was 14.4 mmHg (95% CI 14.2-14.7), which is a mean reduction of 11.8 mmHg (95% CI 11.4-12.2). An unqualified success, in terms of the main outcome measure, was achieved in 66.6% of patients and a qualified success in 71.0%. An unqualified success, in terms of a final IOP of less than 21 mmHg, was achieved in 84.0% of cases, and a qualified success in 92.0%. Visual fields were stable in 84.2%. Outcome was not related to consultants' specialist interest, level of activity, type of hospital, or region. CONCLUSIONS: The success rates reported in this paper represent the national experience of first-time trabeculectomy for open-angle glaucoma in the UK. The national success rate at one year compares favorably with many studies in the literature. This survey provides valid and clinically relevant measures of success for the production of guidelines and standards for audit at regional, local and individual levels, and a baseline for the comparison of new therapies.
Dr B. Edmunds, Royal College of Ophthalmologists, 17 Cornwall Terrace, London NW1 4QW, UK. beth@ukonline.co.uk
Classification:
12.8.1 Without tube implant (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
