[Trabeculectomy in black Africans in primary open angle glaucoma]

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Surgical Techniques

Background:

• Open-angle glaucoma is a leading cause of irreversible blindness globally.
• Trabeculectomy is a common surgical procedure to lower intraocular pressure (IOP) in glaucoma patients.
• Assessing surgical outcomes in specific ethnic groups, like Black Africans, is crucial due to potential variations in disease presentation and response.

Purpose of the Study:

• To evaluate the efficacy and outcomes of simple trabeculectomy in Black African patients diagnosed with open-angle glaucoma.
• To compare the success rates of limbal-based versus fornix-based conjunctival flaps in trabeculectomy.
• To identify complications and failure rates associated with the procedure in this population.

Main Methods:

• Retrospective study of 80 eyes from 62 patients with primary open-angle glaucoma.
• Cairn's trabeculectomy performed without antimetabolites.
• Comparison of outcomes between limbal-based (37 eyes) and fornix-based (43 eyes) conjunctival flaps.
• Success and failure rates assessed using Kaplan-Meier survival analysis.

Main Results:

• Mid-term follow-up revealed frequent complications, with pathological blebs in 22.5% of cases.
• Success rates varied significantly by flap type: limbal-based flap showed 97% success at 12 months, decreasing to 54% at 36 months.
• Fornix-based flaps demonstrated lower success rates (46% at 12 months, 18% at 36 months). Overall failure rate was 33.75%, predominantly with fornix-based flaps.
• Failures typically occurred within the first year post-surgery.

Conclusions:

• Trabeculectomy with a limbal-based conjunctival flap demonstrates mid-term success in Black African patients with open-angle glaucoma.
• Challenges in patient follow-up in African settings pose significant difficulties for long-term outcome assessment of trabeculectomy.
• The choice of conjunctival flap significantly impacts surgical success rates.