Pressure Results of Primary Open-Angle Glaucoma Surgery by Trabeculectomy in Kankan, Guinea

Research Article

J Ophthalmol & Vis Sci. 2023; 8(3): 1085.

Pressure Results of Primary Open-Angle Glaucoma Surgery by Trabeculectomy in Kankan, Guinea

Sovogui Md1,2*; Zoumanigui2; Doukoure MB2; Camara F3; Vonor K4

¹Faculty of Health Sciences and Techniques, University of Conakry, Republic of Guinea

²Bartimee Ophthalmological Clinic, Republic of Guinea

³Kankan Regional Hospital, Republic of Guinea

4University of Kara in Togo, Republic of Guinea

*Corresponding author: Maxime Dantouma SOVOGUI Assistant at the Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University. BP: 2525 Conakry, Republic of Guinea. Tel: +224 628 17 93 23 Email: maximesovo79@gmail.com

Received: July 05, 2023 Accepted: August 08, 2023 Published: August 15, 2023

Summary

Purpose: To assess the pressureal outcomes of primary open-angle trabeculectomy surgery for primary open-angle glaucoma.

Materials and Methods: This was a six-month prospective observational study. Patients operated by the trabeculectomy technique and followed during the study period were included. Not included were those who had combined surgery. Recruitment was comprehensive. Our variables were epidemiological, clinical, paraclinical and therapeutic. Epi info version 7.4.0 was used for data analysis.

Conclusion: Glaucoma remains a public health problem in Kankan. Trabeculectomy concluded an overall success in lowering postoperative intraocular pressure with almost no complications. Given these results, it would be better to undertake it in 1st intention.

Keywords: Glaucoma; Trabeculectomy; Guinea

Introduction

Glaucoma is a group of progressive and degenerative optic neuropathies with irreversible loss of visual field (CV) and can lead to blindness [1]. Intraocular hypertension is the main risk factor. Diagnosis and monitoring are based on a joint analysis of structural involvement by clinical examination of the papilla supplemented by Optical Coherence Tomography (OCT) and functional impairment, by the realization of CV. Treatment consists of reducing Intraocular Pressure (IOP), thus slowing the progression of the disease, through medical, physical (laser) treatments and surgical [2]. Surgery is the most effective way to lower IOP. It is usually offered when the maximum tolerated medical treatment is insufficient to achieve a target IOP. Many incisional techniques of variable mode of action facilitate the evacuation of aqueous humor out of the anterior chamber. Some make it possible to remove the trabecular obstacle in whole (trabeculectomy) or in part (deep non-perforating sclerectomy) and others (micro invasive) try to restore the physiological flow of aqueous humor by trabecular and / or uveoscleral route. Trabeculectomy is a reference technique but depends on a filtration bubble and its complications requiring very rigorous and prolonged monitoring for life. The failure of this technique is almost always due to the healing of the conjunctiva and Tenon capsule [3]. In Ireland in 2020, in a study of trabeculectomy with the use of Mitomycin C, IOP was 10.8±4.8 mm Hg representing a 47% reduction in IOP from baseline [4]. In the Democratic Republic of Congo in 2017, after trabeculectomy associated with anti-VGEF in the management of neovascular glaucoma, the mean IOP of 38 mm Hg preoperatively, increased to 15 mm Hg postoperatively [5]. In Togo in 2017, Maneh et al [6] reported in a study of trabeculectomy outcomes in childhood glaucoma, that the mean preoperative IOP was 20.08 mm Hg increasing to 12.86 mm Hg, 6 months later with 62.86% success. In the Republic of Guinea, Sovogui MD et al. [7] in their study of Non-Perforating Deep Sclerectomy (NPPS), report that the mean preoperative IOP was 19±5.73 mm hg versus 11.6±1.86 mm hg on postoperative Day 30. However, it seemed interesting to us to evaluate the functional results of Trabeculectomy at Kankan Regional Hospital.

Materials and Methods

This was a six-month prospective observational study from 01 March 2022 to 31 August 2022. It took place in the ophthalmology department of Kankan Regional Hospital and the Nabaya Yelen application center in Kankan. Due to their administrative positions and equipment, they are the largest ophthalmology departments in the Kankan administrative region. Patients operated by the trabeculectomy technique and followed during the study period were included in this study. Not included were those who received combined surgery (cataract-glaucoma). The recruitment was exhaustive according to our selection criteria. Our variables were epidemiological, clinical, paraclinical and therapeutic. Epi info version 7.4.0 was used for data analysis; Word and Excel software from the Office 2016 pack were used for text and table entry; Zotero version 5.0.96.2 was used for bibliographic references. The confidentiality and anonymity of interviewees were respected in accordance with the principles of ethics and medical deontology.

Results

In all, 2401 patients including 47 patients were received in whom 79 eyes were operated for glaucoma by the technique of Trabeculectomy, a frequency of 1.95%. The figure below shows the considerable normalization of IOP postoperatively, compared to preoperative IOP. Table I shows that poor compliance with treatment was the most frequent operative indication.Table II shows that the 41-60 age group is more represented with a male predominance. Average age 41.88±24.98 extreme years 1 month and 76 years; Sex ratio 1.61.Table III on clinical variables shows that decreased visual acuity was the most common reason, high blood pressure (hypertension) was the most dominant antecedent. Both eyes were more affected at the same time. In Table IV, visual acuity by far without carried correction (AVLSC) =3/10 was the most dominant. According to Table V shows that, the optical fiber thickness at OCT-RNFL was < 88μm plus severe optical disc damage in the majority of cases. On the CV, the Mean Defect was > -12 dB in almost half of the cases. The only complication found postoperatively in this study was hyphema, encountered in only one patient.