The National Survey of Trabeculectomy. I. Sample and methods

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Public Health

Background:

• Trabeculectomy is a common surgical procedure for glaucoma.
• Understanding current practices and outcomes is crucial for improving patient care.
• The National Survey of Trabeculectomy aimed to provide this insight in the UK.

Purpose of the Study:

• To evaluate current trabeculectomy practices in the United Kingdom.
• To determine national success and complication rates of trabeculectomy.
• To report on consultant activity, waiting times, indications, and patient demographics.

Main Methods:

• A national survey of consultant ophthalmologists performing trabeculectomy in the UK.
• Retrospective sampling of four consecutive patients per consultant prior to June 1996.
• Prospective follow-up of patients at 6 and 12 months post-surgery, with data collected via postal questionnaires.
• A validation study in 14 units to assess selection and reporting bias.

Main Results:

• 1454 patients from 382 consultants were analyzed; mean patient age was 69.2 years, 51.7% male.
• Primary open-angle glaucoma was the most common diagnosis (89.2%).
• Indications included uncontrolled intraocular pressure (57.1%) and progressive visual field loss (26.5%). Half the patients had advanced visual field damage at listing.
• 80% of trabeculectomies were performed within 3 months, though nearly a third of consultants felt waiting times were too long.

Conclusions:

• The survey reflects current UK trabeculectomy practices, highlighting considerable variation.
• Failure of medical management to control intraocular pressure remains the primary indication for surgery.
• Advanced glaucomatous damage was common at surgery, and while most waits were within 3 months, perceived delays were significant.