Transcript Audit: Mitomycin C Trabeculectomy

HEFT Audit Nov 2008
Trabeculectomy +
Antiscarring Mitomycin C
Prof Peter Shah
Mr Aruna Dharmasena
Dr Freda Sii
Patient Demographics
• Number of cases: 449
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Male
Female
M:F ratio
Mean age
Range
Mean age - Male:
Mean age - Female:
171
160
1.1
58y
6 – 87y
56.2y
59.9y
Mean age at the time of Surgery
90
80
70
60
50
40
30
20
10
0
Female
Male
Case note retrieval at 1 year
ReGAE
97%
National Survey of
Trabeculectomy
85%
Ethnicity
Unk nown
other 1.8%
0.5%
AFC
14.1%
Asian
8.7%
C aucasian
74.9%
Ethnicity
A FC
A sian
C aucasian
other
Unk nown
Aetiology
of Glaucoma (n = 449)
Developmental (n = 7)
Ant Segment Dysgenesis
( n= 5)
Primary (n = 303)
Sturge-Weber
(n = 2)
NTG
12%
Acquired (n = 442)
Open Angle ( n= 272)
JOAG
8%
Developmental
2%
Secondary
31%
POAG
40%
Secondary (n = 139)
Closed angle (n = 31)
Inflammatory (n = 65)
POAG (n = 178)
Pigmentary (n = 15)
NTG (n = 56)
PXF (n = 12)
JOAG (n = 38)
Trauma (n = 12)
Steroid induced (n = 4)
SACG (n = 4)
PACG
7%
Other (n = 27)
Distribution of pre-op Highest, pre-op Mean and Immediate pre-op IOP
Variable
Pre-op IOP (highest)
Pre-op IOP (Mean)
IOP Immediate Pre-op
100
Number of Patients
80
60
40
20
0
12
24
36
48
IOP (mmHg)
60
72
Maximum
Median
Mean
St. Dev
SE Mean
Highest Pre-op IOP
76
33
34.2
11.8
0.6
Mean Pre-op IOP
48
22
22.7
6.5
0.3
Immediate Pre-op IOP
54
21
22.9
7.3
0.4
Post-op Follow-up
(all cases)
500
449
Number of Patients
400
299
300
216
200
167
114
79
100
5 Years FU
4 Years FU
3 Years FU
2 Years FU
1 Year FU
<1 Year FU
0
Follow-up (Years)
Mean
SE Mean
St Dev
Median
Range
28.1months
1.2
26.05
20.0
0-100 months
Outcome – High Pressure Glaucoma (n=393)
Qualified
Success
Inadequate
Control
Further
Surgery/
Cyclodiode
Excluded
Sight
Threatening
Complications
Total
At the end
of 1st Year
At the end
of 2nd Year
At the end
of 3rd Year
At the end
of 4th Year
At the end
of 5th Year
95.2%
95.7%
97.9%
94.7%
97.0%
{239/(265-14)}
{178/(190-4)}
{138/(148-7)}
{90/(99-4)}
{61/(67-4)}
8
(1 NPL eye)
5
3
3
0
1 - Redo
1 – Re-do
1- Tube
2 – CDX
2 – Died
5 – No 3YData
1 - Transferred
2 – Died
1 – No 4YData
2 – Died
2 – No 4YData
3 - Redo
1 - Transferred
5 – Died
8 – No 1Y Data
1 - Redo
1 – Tube
1 – Failed + Trf
1 – Died
3 – No 2Y Data
1Endophthalmitis
0
0
0
0
265
190
148
99
67
Distribution of post-op IOP in HighTension Glaucoma patients with
qualified success
Post OP
IOP
1y
(n=251)
2y
(n=186)
3y
(n=141)
4y
(n=95)
5y
(n=63)
≤ 21mmHg
95.2%
95.7%
97.9%
94.7%
97.0%
(239)
(178)
(138)
(90)
(61)
93.6%
91.9%
95.0%
94.7%
95.2%
(235)
(171)
(134)
(90)
(60)
80.9%
77.4%
80.1%
79.0%
81.0%
(203)
(144)
(113)
(75)
(51)
58.6%
51.6%
51.8%
52.6%
69.8%
(96)
(73)
(50)
(44)
≤ 18mmHg
≤ 15mmHg
≤ 12mmHg
(147)
Distribution of post-op IOP in NTG
(n = 56)
1y Post-op
n=34
2y Post-op
n=26
3y Post-op
n=19
≥ 10% IOP Drop
100%
(34)
96.2%
(25)
100%
(19)
≥ 20% IOP Drop
94.1%
(32)
84.6%
(22)
89.5%
(17)
≥ 30% IOP Drop
79.4%
(27)
65.4%
(17)
73.7%
(14)
≥ 40% IOP Drop
73.5%
(25)
38.5%
(10)
36.9%
(7)
0
0
0
Further Surgery / Sight
Threatening
Complications
Success at 1 year
ReGAE
National Survey of
Trabeculectomy
95%
92%
[POAG, JOAG, NTG,
[POAG, NTG, PXF, PDG]
PACG, Developmental,
Complex secondary]
ReGAE database %
[n=449 single surgeon]
National Survey of
Trabeculectomy %
[n=1240, 310 surgeons]
0.2
0.3
Blebitis <1Y
0
N/A
Blebitis >1Y
0.4
N/A
Hyphaema <10%
4.7
24.6%
Hyphaema >10%
0
Complications
Endophthalmitis
Suprachoroidal Hge
0.2
N/A
Hypotony Maculopathy
0.2
0.2
0
0.4
5.0
14.1
0
0.2
T.A.S.S
0.2
N/A
Aqueous Misdirection
0.2
N/A
> 3 lines VA loss
0.4
N/A
CMO
0.2
0.1
Corneal Decompensation
0.2
N/A
Significant increase in ERM
0.2
N/A
Wipe Out
Choroidal Effusion
Malignant Glaucoma
References
1.
2.
3.
Edmunds B, Thompson JR, Salmon JF, Wormald RP.
The national survey of trabeculectomy l. Sample and
methods. Eye 1999; 13: 524–530.
Edmunds B, Thompson JR, Salmon JF, Wormald RP.
The national survey of trabeculectomy. II. Variations in
operative technique and outcome. Eye 2001; 15: 441–
448.
Edmunds B, Thompson JR, Salmon JF, Wormald RP.
The National Survey of Trabeculectomy. III. Early and
late complications. Eye (2002) 16, 297–303.