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Trabeculectomy (With Cytotoxic Adjunct) As First Line of Treatment in Chronic Glaucoma at a Rural Secondary Level Hospital in South Africa

Una Kyriacos and Nazlee October

Aim: To determine the incidence of trabeculectomy (with cytotoxic adjunct) as the first line of treatment in chronic glaucoma and to describe demographic data, visual acuity, Cup/Disc ratio and intraocular pressure at the time of diagnosis, and, if surgery was delayed, to describe data at the time of surgery to determine the efficacy of pharmacological management.
Design: Retrospective record review for the period 1 March 2002 to 2006.
Results: Record review included 128 eyes of 64 consecutive chronic glaucoma patients diagnosed with primary open angle glaucoma. Trabeculectomy with cytotoxic adjunct had been performed on 24 eyes of 24 patients (37.5%). The mean age of the sample of 12 females and males was 56 years representing a South African population profile of 18 Coloured, 3 African Black and 3 White persons. Pharmacological management was the first line of treatment for all patients for a period of3 days to 2 years 7 months. All patients had decreased vision at the time of surgery but intraocular pressure was lower (30.8 to 28.1 mm Hg) in the operative eye.
Conclusions: The first line of treatment for chronic glaucoma was medical management contrary to National Guidelines recommending trabeculectomy with cytotoxic adjunct.