ReGAE 7: long-term outcomes of augmented trabeculectomy with mitomycin C in African Caribbean patients

Abstract

To evaluate long-term outcomes and complication rates following trabeculectomy with mitomycin C in a case series of African Caribbean patients. A prospective, observational and non-comparative case series. Forty-seven consecutive African Caribbean patients (47 eyes) with glaucoma. All patients underwent augmented trabeculectomy with mitomycin C for uncontrolled intraocular pressure (IOP). Survival analysis was performed with a minimum of 12 months' follow up. Surgical success was based upon IOP reduction to ≤ 21 mmHg, ≤ 18 mmHg and ≤ 15 mmHg without glaucoma medication (complete); or IOP reduction to ≤ 21 mmHg, ≤ 18 mmHg and ≤ 15 mmHg with or without glaucoma medication (qualified). The mean follow-up period was 48.6 months. At 3 years post-trabeculectomy 92.6% achieved a qualified success and 59.3% a complete success for an IOP ≤ 21 mmHg. At final follow up the mean IOP reduced from 33.7 mmHg to 13.1 mmHg (P < 0.0001). Survival rates were 96%, 90% and 86% at 12, 24 and 36 months, respectively, with a mean survival time of 97.4 months (95% confidence interval, 86.0-108.8) for an IOP ≤ 21 mmHg. Early postoperative hypotony requiring surgical intervention occurred in four (8.5%) patients. There were no cases of blebitis, endophthalmitis, suprachoroidal haemorrhage, malignant glaucoma or hypotony maculopathy. Good long-term stable IOP can be achieved with low complication rates and high success rates amongst African Caribbean patients following trabeculectomy with mitomycin C. A proactive postoperative management regime is needed to ensure trabeculectomy survival in high-risk populations.