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.