Surgical trends in glaucoma management: The current Indian scenario

To assess the current trend in the surgical management of glaucoma in India.

An anonymous online survey evaluating the preferred choices in the surgical management of glaucoma was circulated among the members of Glaucoma Society of India (GSI). Survey responses were compared to prior survey among GSI members in 2013 and members of American Glaucoma Society (AGS), 2016.

A total of 175 of 879(20%) GSI members participated in the survey of which 75.3% of the survey participants were practicing in the private sector. Trabeculectomy with or without augmentation with Mitomycin C(MMC) was the first-choice glaucoma incisional surgery for 96.6% of the survey participants. Of the participants doing tube surgery, use of valved GDD was the preferred choice (83.4%). Re-trabeculectomy was the preferred approach (60.7%) in case of trabeculectomy failure. For paediatric glaucomas, combined trabeculotomy with trabeculectomy was the preferred surgical approach for both hazy cornea (84.5%) as well as clear cornea (66%). For a POAG patient without prior incisional surgery and presenting with visually significant cataract, phacoemulsification with trabeculectomy was the preferred management approach by 58.7% of the participants.

Trabeculectomy continues to be the clear winner for the Indian glaucoma surgeon because of its cost effectiveness, lack of expensive instrumentation, and a more robust surgical training for trabeculectomy during residency programs. A higher proportion of angle closure disease precludes the use of minimally invasive glaucoma surgery and very often tube shunts also. Economics, ease of access and follow-up made a combined cataract and glaucoma surgery a preferred choice among Indian surgeons.