Outcome of glaucoma surgery at Mombasa Light House for Christ Eye Centre

Abstract

OBJECTIVES: The main objective was to evaluate the outcome of glaucoma surgeries in a centre for eye care in Kenya. The main outcomes were intraocular pressure control, changes of the cup: disc ratio, visual field (VF) changes and short term postoperative complications. DESIGN: Retrospective case series. SETTING: The study was conducted at Mombasa Light House for Christ Eye Centre, a referral centre serving the Coastal region of Kenya, and parts of Eastern and Northern Provinces of Kenya. Mombasa is the second largest town in Kenya. SUBJECTS: All patients diagnosed to have glaucoma and managed by surgery between 2004- 2007. MATERIALS AND METHODS: Records from 2004 to 2007 were retrieved and data collected on the surgeries done using a structured questionnaire. 2008 was left for follow up to avail a one year minimum follow up time. Analysis was done using SPSS version 13. RESULTS: 265 operations were recorded in this period. 213 were retrieved and the outcomes analysed. Males were 65%. The mean age was 56.1, while the range was 1-90 years. Six cases had congenital glaucoma. 90.6% of the eyes were diagnosed using cup to disc ratio and intra-ocular pressure assessment. 7% had gonioscopy. Baseline VF were available for only three cases hence VFs were not analysed. Trabeculectomy was performed in 96% of the patients (n~213). Argon Laser Trabeculoplasty, peripheral iridectomy and an Ahmed valve were done for the others. (4%). 7% percent of the surgeries had antimetabolites used, mainly 5-FU and mitomycin-C. 35% had combined trabeculectomy and cataract surgery. In 166 (77.9%) of cases, there were no complications. 47 (22.1%) had early postoperative complications. Of these, hypotony was the commonest (68%). Others included hlcb failure (19%) and hyphema (9%), while infection and severe inflammation were 4%.7 patients (15%) needed to be taken back to surgery for management of the complications. i he average intra-ocular pressure at two year follow up was 15.0mmHg against a baseline of 28.7mm!lg (p< 0.001). 29 eyes (13.6%) required medication for intraocular pressure control. One type of medication was able to control the pressures post operatively. Surgery reduced topical antiglaucoma medication use by 72%. Cup to disc ratios were stabilised after surgery with no significant decay during the follow up time (p=0.449 at 6months and 0.114 at 2yrs). There was an apparent improvement post surgery. Most patients were operated late with 68% presenting with cup to disc ratios of >0.8. Post-op follow up was poor with a drop to 58% by the third visit. CONCLUSION: Intra-ocular pressure was well controlled for the two year follow up. Cup to disc ratio was well controlled with even an apparent improvement post surgery in some cases. Complications though present could mostly be managed conservatively with a low re-operation rate. RECOMFNDATIONS: Surgical intervention can be taken as a first option for glaucoma control in our set up. Further studies should be done to ascertain whether or not there is an improvement in cup to disc ratio following glaucoma surgery in our set up