M.Med. Faculty of Health Sciences, University of the Witwatersrand, 2009 / Purpose
To compare the outcomes of primary viscocanalostomy with trabeculectomy augmented
with mitomycin C (MMC) in black South African patients with primary open-angle
glaucoma (POAG).
Method
A prospective, randomized study was conducted over a four year period. Fifteen black
South African patients with bilateral open-angle glaucoma requiring surgery that met the
inclusion criteria and gave informed consent to participate in the trial were randomized to
receive either a viscocanalostomy or a trabeculectomy with MMC in the first eye
requiring surgery. The fellow eye then received the alternate procedure. Patients were
followed up for two years postoperatively.
Results
There were no significant differences between the two surgical groups preoperatively.
Twelve eyes in each group were followed for twenty-four months. In both groups the
intraocular pressure (IOP) was significantly reduced post-operatively (p < 0.01) and the
average number of medications used per eye was significantly reduced (p < 0.02). At
twenty-four months, complete success (IOP less than or equal to 18mmHg without
glaucoma medication and with no evidence of glaucoma progression) was seen in 75% of
eyes undergoing trabeculectomy with MMC that completed the follow up, but in only
33% of eyes undergoing viscocanalostomy (p = 0.0498). Survival curves for both success
and qualified success (IOP less than or equal to 18mmHg with glaucoma medications) in
the two surgical procedures confirmed the superiority of trabeculectomy with MMC over
viscocanalostomy.
Conclusion
Viscocanalostomy may offer some advantages because it is less invasive, but intraocular
pressure control appears to be superior with trabeculectomy with MMC and this
continues to be the filtering procedure of choice for the management of glaucoma in
black South African patients.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/7212 |
| Date | 08 September 2009 |
| Creators | Williams, Susan Eileen IsabellaI |
| Source Sets | South African National ETD Portal |
| Language | Spanish |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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