[Trabeculectomy in black Africans in primary open angle glaucoma]

To assess simple trabeculectomy in black Africans with open angle glaucoma.

We studied retrospectively 80 eyes of 62 patients with primary open angle glaucoma operated by Cairn's trabeculectomy without adjunction of antimetabolites. Thirty seven eyes had a limbal-based conjunctival flap and the others 43 had a fornix-based conjunctival flap. Failures and success were assessed with the Kaplan-Meier's method.

Patients were all seen at least 12 months after surgery. The mean follow up was 24 months. At mid-term survey we found complications to be frequent. Pathological blebs occurred in 22.5% (18 cases). The survival probability grew shorter with time. Only 44% of patients were reviewed at 36 months and 29% at 48 months. The success rate (IOP less than 21 mmHg of all glaucoma medications) varied according to the conjunctival flap. It was respectively at 12 months, 24 months and 36 months: 97%, 70 % and 54% with limbal-based flap, and 46%, 18% and 18% with fornix-base flap. The overall rate of tonometric failures was 33.75%. Failures were more often with fornix- based flap (85%). Generally they set in before one year of survey. This was so in 91% of absolute failures and in 87% of relative failures. The failures rate seems to increase with topical polytherapy given more than 12 months before operation.

Trabeculectomy with limbal-based conjunctival flap is at mid-term follow up successful in black Africans. However the following up difficulties in Africa makes it a too delicate assessment objective for long-term results of trabeculectomy.