Initial Treatment of Glaucoma in a Rural Eye Clinic in Cameroon: Surgery or Medications

Abstract

Objective: To report the outcome at one year after  primary trabeculectomy with application of mitomycin-C in patient with primary open angle glaucoma  in a rural Black West African population in Cameroon. Patients and Methods: Sixty three consecutive patients were enrolled in this retrospective study. Outcomes measured were post operative visual acuity, intra ocular pressure and complications at one year follow up.  Absolute success was achieved when the IOP was ≤20 without adjuvant medication. Results: Sixty three records (57.14 % (n=36) males and 42.86% (n=27) females) were included in this study. The mean age was 56±14 years. The preoperative NCVA was   ≥0.2 in 73.01% of eyes (n=46). At one year follow up visual acuity was stable in 79.36% (n=50) eyes. The mean preoperative IOP was 34±3.30mmHg, given a target IOP of 19.44mmHg. The mean postoperative IOP was 17.60±4.70mmHg. This was significantly lower than the target pressure (p=0.001). Trabeculectomy was indicated at the first consultation in 76.20% (n=48) patients. The absolute success rate was achieved in 73.01% of cases. Post operative complications included: 7 intraocular inflammations, 3 early IOP elevation, 11 late IOP elevation, 12 cataracts and 1 endophtalmitis. Conclusion: Trabeculectomy with anti metabolites, can be an effective method of reducing the long-term risk of glaucomatous progression in Africa despite potential limitations in patient follow-up.