HEFT Audit Nov 2008 Trabeculectomy +
Antiscarring Mitomycin C
Prof Peter Shah
Mr Aruna Dharmasena
Dr Freda Sii
Patient Demographics
• Number of cases: 449• Male 171• Female 160• M:F ratio 1.1• Mean age 58y• Range 6 – 87y• Mean age - Male: 56.2y • Mean age - Female: 59.9y
90
80
70
60
50
40
30
20
10
0
Female Male
Mean age at the time of Surgery
Case note retrieval at 1 year
ReGAE National Survey of
Trabeculectomy
97% 85%
AFCAsianCaucasianotherUnknown
Ethnicity
Unknown1.8%other
0.5%
Caucasian74.9%
Asian8.7%
AFC14.1%
Ethnicity
POAG40%
J OAG8%
Developmental2%
Secondary31%
PACG7%
NTG12%
Aetiology of Glaucoma (n = 449)
Developmental (n = 7) Acquired (n = 442)
Primary (n = 303) Secondary (n = 139)
Open Angle ( n= 272) Closed angle (n = 31)
POAG (n = 178)
NTG (n = 56)
JOAG (n = 38)
Ant Segment Dysgenesis( n= 5)
Sturge-Weber (n = 2)
Inflammatory (n = 65)
Pigmentary (n = 15)
PXF (n = 12)
Trauma (n = 12)
Steroid induced (n = 4)
SACG (n = 4)
Other (n = 27)
726048362412
100
80
60
40
20
0
IOP (mmHg)
Num
ber
of Patients
Pre-op IOP (highest)Pre-op IOP (Mean)IOP Immediate Pre-op
Variable
Distribution of pre-op Highest, pre-op Mean and Immediate pre-op IOP
Maximum Median Mean St. Dev SE Mean
Highest Pre-op IOP 76 33 34.2 11.8 0.6
Mean Pre-op IOP 48 22 22.7 6.5 0.3
Immediate Pre-op IOP 54 21 22.9 7.3 0.4
Post-op Follow-up(all cases)
449
299
216
167
114
79
0
100
200
300
400
500
<1
Ye
ar
FU
1
Ye
ar
FU
2 Y
ea
rs F
U
3 Y
ea
rs F
U
4 Y
ea
rs F
U
5 Y
ea
rs F
U
Follow-up (Years)
Nu
mb
er
of
Pa
tie
nts
Mean SE Mean St Dev Median Range
28.1months 1.2 26.05 20.0 0-100 months
Outcome – High Pressure Glaucoma (n=393)
At the end
of 1st YearAt the end of 2nd Year
At the end of 3rd Year
At the end of 4th Year
At the end of 5th Year
Qualified Success
95.2%{239/(265-14)}
95.7%{178/(190-4)}
97.9%{138/(148-7)}
94.7%{90/(99-4)}
97.0%{61/(67-4)}
Inadequate Control
8
(1 NPL eye)
5 3 3 0
Further Surgery/ Cyclodiode
3 - Redo
1 - Redo
1 – Tube
1 – Failed + Trf
1 - Redo 1 – Re-do
1- Tube2 – CDX
Excluded
1 - Transferred
5 – Died
8 – No 1Y Data
1 – Died
3 – No 2Y Data
2 – Died
5 – No 3YData
1 - Transferred
2 – Died
1 – No 4YData
2 – Died
2 – No 4YData
Sight Threatening Complications
1 - Endophthalmitis
0 0 0 0
Total 265 190 148 99 67
Distribution of post-op IOP in High-Tension Glaucoma patients with
qualified success
Post OP IOP
1y
(n=251)
2y
(n=186)
3y
(n=141)
4y
(n=95)
5y
(n=63)
≤ 21mmHg 95.2%(239)
95.7%(178)
97.9%(138)
94.7%(90)
97.0%(61)
≤ 18mmHg 93.6%(235)
91.9%(171)
95.0%(134)
94.7%(90)
95.2%(60)
≤ 15mmHg 80.9%(203)
77.4%(144)
80.1%(113)
79.0%(75)
81.0%(51)
≤ 12mmHg 58.6%(147)
51.6%(96)
51.8%(73)
52.6%(50)
69.8%(44)
Distribution of post-op IOP in NTG (n = 56)
1y Post-op
n=34
2y Post-op
n=26
3y Post-op
n=19
≥ 10% IOP Drop100%
(34)
96.2%
(25)
100%
(19)
≥ 20% IOP Drop94.1%
(32)
84.6%
(22)
89.5%
(17)
≥ 30% IOP Drop79.4%
(27)
65.4%
(17)
73.7%
(14)
≥ 40% IOP Drop73.5%
(25)
38.5%
(10)
36.9%
(7)
Further Surgery / Sight Threatening Complications
0 0 0
Success at 1 year
ReGAE National Survey of Trabeculectomy
95%
[POAG, JOAG, NTG, PACG, Developmental, Complex secondary]
92%
[POAG, NTG, PXF, PDG]
Complications ReGAE database %
[n=449 single surgeon]
National Survey of Trabeculectomy %
[n=1240, 310 surgeons]
Endophthalmitis 0.2 0.3
Blebitis <1Y 0 N/A
Blebitis >1Y 0.4 N/A
Hyphaema <10% 4.7 24.6%
Hyphaema >10% 0
Suprachoroidal Hge 0.2 N/A
Hypotony Maculopathy 0.2 0.2
Wipe Out 0 0.4
Choroidal Effusion 5.0 14.1
Malignant Glaucoma 0 0.2
T.A.S.S 0.2 N/A
Aqueous Misdirection 0.2 N/A
> 3 lines VA loss 0.4 N/A
CMO 0.2 0.1
Corneal Decompensation 0.2 N/A
Significant increase in ERM 0.2 N/A
References
1. Edmunds B, Thompson JR, Salmon JF, Wormald RP. The national survey of trabeculectomy l. Sample and methods. Eye 1999; 13: 524–530.
2. Edmunds B, Thompson JR, Salmon JF, Wormald RP. The national survey of trabeculectomy. II. Variations in operative technique and outcome. Eye 2001; 15: 441–448.
3. Edmunds B, Thompson JR, Salmon JF, Wormald RP. The National Survey of Trabeculectomy. III. Early and late complications. Eye (2002) 16, 297–303.