Optimizing Filtration Surgery Procedures in African-Derived Populations: Trabeculectomy and Preserflo.

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Population Health

Background:

• African-derived populations experience disproportionately higher rates of primary open-angle glaucoma (POAG).
• These populations also face increased risks of surgical failure due to unique anatomical and genetic factors.
• Existing glaucoma care models may not adequately address the specific needs of patients from African-derived backgrounds.

Purpose of the Study:

• To identify challenges in glaucoma care for African-derived populations.
• To propose strategies for optimizing surgical outcomes in this patient group.
• To provide evidence-based, culturally informed recommendations for glaucoma surgery.

Main Methods:

• Convened six UK-based consultant ophthalmic glaucoma surgeons with diverse patient experience.
• Supplemented surgeon opinions with a review of published literature.
• Developed tailored recommendations based on collective expertise and evidence.

Main Results:

• Key surgical challenges include Tenon's thickness, variable wound healing, and increased scarring risk.
• Preoperative optimization involves patient education, counselling, and ocular surface management.
• Intraoperative and postoperative strategies include tailored mitomycin C use, specific wound closure techniques, and intensified immunosuppression.

Conclusions:

• Culturally informed, evidence-based glaucoma care is essential for patients of African descent.
• Personalized and proactive surgical approaches can lead to more consistent and favorable outcomes.
• Addressing specific challenges can improve the success rates of glaucoma filtration surgery in this population.