Abstract
Introduction:
The glaucomas often co-exist with cataract. We previously reported a large trial of anti-scarring treatment in combined phacotrabeculectomy surgery. Long-term outcomes in an African population are extremely rarely reported. We present here the outcomes in IOP, acuity, bleb morphology and patient perceptions at 3–5-years post surgery.
Methods:
Tanzanian patients with glaucoma and visually significant cataract underwent combined phacotrabeculectomy surgery. In November 2015 an attempt was made to contact all participants in the study inviting them for a repeat examination. All who attended were given a detailed examination. A semi-structured interview in Swahili was administrated to determine patient experience and satisfaction with the surgery.
Results:
Sixty-eight (23%) attended for repeat review in 2015. The mean time from original surgery was 4.5-years (range 2.3–6.6-years). Overall 53 (78%) had IOP < 21 mm Hg and 29 (43%) an IOP < 16 mm Hg at final follow-up. A flat bleb at 26 and 100 days was associated with failure by IOP criteria at 4.5-years post-operatively. A vascular bleb at those time points was not any more associated with late failure than a non-vascular bleb. A majority of patients were pleased with the surgery. The cost of surgery is high but it is a price patients were willing to pay. Nearly all patients (95%) would recommend the service to family and friends.
Discussion:
Owing to the small proportion reviewed, our conclusions are severely limited. Phacotrabeculectomy worked well in a majority of the reviewed population long-term and is accepted by a majority of these patients as worthwhile.
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Acknowledgements
This project could never have been realised without the assistance of patients and staff at CCBRT Hospital Dar es Salaam Tanzania. The project was funded through grants from BandAid via Fight for Sight and the British Council for the Prevention of Blindness. Technical and logistical assistance from Pak Sang Lee was essential. Erasto Nyakaselula was our translator for the qualitative interviews and Westory Masawe the optometrist who assisted in data collection for the final follow-up. We are extremely grateful to all of the above for their hard work and assistance in ensuring the successful outcome of this project.
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Murdoch, I., Baker, H., Odouard, C. et al. Long-term follow-up of phacotrabeculectomy surgery in Tanzania. Eye 33, 1126–1132 (2019). https://doi.org/10.1038/s41433-019-0384-4
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DOI: https://doi.org/10.1038/s41433-019-0384-4
