Surgical management of primary open-angle glaucoma in Africans

Abstract

Trabeculectomy and its various modifications have been the ‘gold standard’ in the management of glaucoma. However, the risk of sight-threatening complications has remained unacceptably high and some have questioned the belief that trabeculectomy is the best form of treatment for glaucoma. In black Africans, there is the additional problem of a higher tendency for trabeculectomy failure. Compliance with medical therapy is poor. Lasers are expensive and not readily available. Nonpenetrating glaucoma surgeries have been reported to be less effective than trabeculectomy but with a better safety profile. However, the skill for these procedures is not yet readily available in Africa. Tube shunt and cyclodestructive procedures are available for refractory or complicated cases. Newer techniques such as canalostomy are being developed. Further research to find a new surgical procedure that is inexpensive, effective, long lasting or permanent, as well as rapid and simple to perform, is required to tackle the problem in sub-Saharan Africa.