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Abstract #15553 Published in IGR 1-3
Glaucoma surgery in the United Kingdom: Why, who and when
Khaw PT; Siriwardena DEye 1999; 13: 493-494
In this editorial the authors comment on a paper by Edmunds et al. on glaucoma surgery in the United Kingdom. In fact this is supposed to be the first paper in a series. The discussed paper deals with indications and demographics. The authors first comment on the magnitude of the problem. Of course glaucoma is a major cause of blindness and second up to one-third of all patients in ophthalmic clinics are glaucoma patients. The national survey of trabeculectomy in the UK is important. Although good results of trabeculectomy have been reported in carefully planned studies one wonders what is happening in the real world. Some 20,000 trabeculectomy operations are performed each year in the UK. In this survey up to 90% of the patients involved had primary open-angle glaucoma, some 5% pseudo-exfoliation, some 4% normal tension glaucoma and 1,5% pigmentary glaucoma. Other forms of glaucoma were excluded. Mean age of the patients was 70 years. The present editors feel that a large number of patients will survive 10 years, emphasizing the importance of continuous success of surgery. Fifty percent of patients had advanced visual field loss at the time of surgery. Failure of medical treatment was cited as the reason for surgery in almost 90% of the patients. Deteriorating visual fields and progressing optic nerve damage were reasons for surgery in some 50 and 25% respectively. This stresses the need for accurate field and disc assessment. An interesting conclusion from this editorial is that the perception that primary surgery is carried out in the UK is wrong. Only some 5% of surgeons reported primary surgery. It seems that only some 4% of glaucoma patients in the UK undergo trabeculectomy. The editors also discuss the potential effect of the use of medication on the success of trabeculectomy. This also reflects the use of anti-metabolites in trabeculectomies.
Prof. P.T. Khaw, Glaucoma Wound Healing Research Unit, Institute of Ophthalmology, Moorfields Eye Hospital, 11-43 Bath Street, London EC1V 9EL; United Kingdom
Classification:
12.1 General management, indication (Part of: 12 Surgical treatment)
