HEFT Audit Nov 2008 Trabeculectomy + Antiscarring Mitomycin C Prof Peter Shah Mr Aruna Dharmasena Dr Freda Sii.

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Presentation transcript:

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

Case note retrieval at 1 year ReGAENational Survey of Trabeculectomy 97%85%

Aetiology of Glaucoma (n = 449) Developmental (n = 7) Ant Segment Dysgenesis ( n= 5) Sturge-Weber (n = 2) Acquired (n = 442) Primary (n = 303) Open Angle ( n= 272) POAG (n = 178) NTG (n = 56) JOAG (n = 38) Closed angle (n = 31) Secondary (n = 139) Inflammatory (n = 65) Pigmentary (n = 15) PXF (n = 12) Trauma (n = 12) Steroid induced (n = 4) SACG (n = 4) Other (n = 27)

MaximumMedianMeanSt. DevSE Mean Highest Pre-op IOP Mean Pre-op IOP Immediate Pre-op IOP

MeanSE MeanSt DevMedianRange 28.1 months months

Outcome – High Pressure Glaucoma (n=393) At the end of 1 st Year At the end of 2 nd Year At the end of 3 rd Year At the end of 4 th Year At the end of 5 th 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) 5330 Further Surgery/ Cyclodiode 3 - Redo 1 - Redo 1 – Tube 1 – Failed + Trf 1 - Redo1 – Re-do 1- Tube 2 – 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 0000 Total

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 Drop 100% (34) 96.2% (25) 100% (19) ≥ 20% IOP Drop 94.1% (32) 84.6% (22) 89.5% (17) ≥ 30% IOP Drop 79.4% (27) 65.4% (17) 73.7% (14) ≥ 40% IOP Drop 73.5% (25) 38.5% (10) 36.9% (7) Further Surgery / Sight Threatening Complications 000

Success at 1 year ReGAENational 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 Blebitis <1Y0N/A Blebitis >1Y0.4N/A Hyphaema <10% % Hyphaema >10%0 Suprachoroidal Hge0.2N/A Hypotony Maculopathy0.2 Wipe Out00.4 Choroidal Effusion Malignant Glaucoma00.2 T.A.S.S0.2N/A Aqueous Misdirection0.2N/A > 3 lines VA loss0.4N/A CMO Corneal Decompensation0.2N/A Significant increase in ERM0.2N/A

References 1.Edmunds B, Thompson JR, Salmon JF, Wormald RP. The national survey of trabeculectomy l. Sample and methods. Eye 1999; 13: 524– Edmunds B, Thompson JR, Salmon JF, Wormald RP. The national survey of trabeculectomy. II. Variations in operative technique and outcome. Eye 2001; 15: 441– Edmunds B, Thompson JR, Salmon JF, Wormald RP. The National Survey of Trabeculectomy. III. Early and late complications. Eye (2002) 16, 297–303.