A Multicenter Study of the Outcomes of Combined Cataract and Trabeculectomy Surgery in Kenya

Abstract

Background: More than90% of the world's visually impaired people live in developing countries. Globally, cataract and glaucoma are the leading causes of blindness accounting for 43% and 12% of the total cases respectively. Objective: To evaluate the outcome of combined trabeculectomy and cataract surgery in terms of intraocular pressure, visual acuity, associated complications, and clinically relevant factors associated with poor outcome. Study Design: Hospital-based retrospective case series. Study Population: Patients who underwent combined cataract and glaucoma surgery at Kisii Eye Hospital, Tenwek Mission Hospital and the Kenyatta National Hospital from January 2012 to December 2016. Data Management and Analysis: Data was collected using questionnaire, analysed using SPSS version 23. Descriptive analysis was done to determine means, frequencies and proportions of the various variables. Where appropriate, Chi-square was used to test association. The confidence level was taken as 95% (p <0.05) where applicable. Results: Study found no statistically significant differences in baseline characteristics and mean IOP between phaco-trab and SICST surgery groups except for LogMAR visual acuity (p = 0.015).Majority of the patients had sustained pressure control especially for the subgroups of patients with longer follow-up. Over 62% of those who returned for 4 – 8 weeks follow-up xiii achieved an improvement in visual acuity and nearly 21% achieving 6/18 or better. Acute postoperative complications included corneal edema, Flat Bleb, Encapsulated Bleb among others. Different age groupings were found to be a significant risk factor for poor visual outcome in patients who underwent combined surgery. Conclusion: Study found different age groupings to be a significant risk factor for poor visual outcome in patients who underwent combined surgery.The poor follow-up limits the precision of the findings but also means that a ‘one stop’ operation for glaucoma and cataract may be a viable and practical approach to management in this setting