Outcome of trabeculectomies without adjunctive antimetabolites

The effectiveness of trabeculectomy in the management of glaucoma is well known. It is the most common intervention for most glaucoma cases treated in the Upper East region. In this region trabeculectomies are, however, performed without adjunctive antimetabolites.

To report on the outcome of trabeculectomy without adjunctive antimetabolites in controlling the intraocular pressures of eyes with Primary Open Angle and Normal Tension Glaucomas.

Retrospective, non-comparative interventional case study

Records of 191 eyes of 164 patients who had undergone standard trabeculectomy were retrospectively analyzed.

Successful intraocular pressure control defined as IOP less than 22 mmHg or a reduction of 30% if pre-operative pressure was already less than 22mmHg.

There were 185 (96.8%) eyes with Primary Open Angle glaucoma and 6 (3.2%) with the Normal Tension variant. Mean age of patients was 50.6 years (Range 17-85) with 22% aged below 40 years. There was a statistically significant difference between the mean pre-op and post-op intraocular pressures (38.09, SD=6.11 versus 18.97, SD=7.28 mmHg respectively); p=0.0001. The procedure was effective in controlling the intraocular pressures to below 22mmHg in 88.46% and below 18mmHg in 67.95% of OAG eyes at six months. In eyes with NTG only one out of six (16.7%) achieved a successful 30% target pressure reduction.

Trabeculectomy alone was effective in controlling IOPs to less than 22 mmHg in POAG. Lower IOP levels needed to control progressive visual field loss may require the use anti-metabolites.