Evaluating the outcomes of glaucoma surgeries at a tertiary eye hospital in Blantyre, Malawi
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Date
2021-01-13
Authors
Journal Title
Journal ISSN
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Publisher
Kamuzu University of Health Sciences
Abstract
Glaucoma is the second commonest cause of blindness and the most common cause of irreversible blindness
worldwide. In developing countries, where the treatment options are limited, management of glaucoma is
challenging. In Malawi, due to various difficulties, including the lack of availability and affordability of a wide
range of medical and laser therapies, surgery is usually advised and planned for within a year of diagnosis for
most patients.
The success rate of surgery depends on several factors, such as the type of surgery performed and the potential
complications during the intra and post-operative period. This success rate is typically measured according to
the reduction in intraocular pressure (IOP) as well as the post-operative visual acuity.
Type of Study
This will be a retrospective case series study.
Problem
There is a paucity of data showing the success rate of adult glaucoma surgery in the Malawian setting. This
study aims to establish a baseline success rate of glaucoma surgeries at a tertiary eye hospital in Blantyre.
Objectives
Broad
To describe the clinical profile and outcomes of adult glaucoma surgeries at LSFEH Blantyre, Malawi in order to
generate therapeutic data to inform improved disease management.
Specific
1. To establish the severity of glaucoma in patients undergoing glaucoma surgeries at LSFEH Blantyre,
Malawi
2. To describe determine pre-operative factors associated with post-operative IOP in adult glaucoma
surgeries at LSFEH Blantyre, Malawi.
3. To establish the post-operative factors associated with post-operative IOP outcome in adult glaucoma
surgeries at LSFEH Blantyre, Malawi.
4. To determine the proportion of successful glaucoma surgeries by comparing the post-operative to the
preoperative IOP.
Study location
This study will be carried out at Lions Sight First Eye Hospital, a referral and teaching eye institution at the
Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. Methodology
Case files of patients who underwent glaucoma surgeries, specifically trabeculectomy, combined
trabeculectomy and cataract surgery and Ahmed valve surgery between March 2019 and February 2020 will be
examined. The following information will be collected from the hospital records: age, gender and demographic details. Details on pre-operative assessment such as visual acuity, intraocular pressure, optic disc appearance
and previous surgery will be recorded. Additionally, details on surgical findings, post-operative visual acuity, IOP
and complications will also be recorded. The required information will be filled into the data collection form (see
appendix 1) and entered into an excel spreadsheet. The data will then be exported to STATA version 16 for
analysis.
The primary outcome measure is post-operative IOP reduction. The mean percentage reduction in IOP will be
shown as column charts and mean IOP reduction will be compared using Wilcoxon’s sign ranked test.
Additionally, the IOP will be categorised into successful and not successful.
Descriptive statistics will be used on and clinical presentation parameters. Categorical data such as gender and
age group will be summarised as frequency distribution tables. Data showing the proportion of cases with intraoperative
and post-operative complications displayed in pie chart form and the various complications will be
presented in bar graphs. A multivariate binary logistic regression model will be used to identify the factors
affecting the outcome.
Hypothesis
We hypothesise that greater than 60% of the patients will have successful glaucoma surgeries. This is based on
observational studies from other African countries.
Results dissemination
Results from the study will be presented at the College of Medicine research dissemination conference with the
intention of publishing in peer-reviewed journals. Additionally, a written report of the final research project will
be submitted to the College of Medicine Research and Ethics Committee (COMREC), College of Medicine Library
and LSFEH Clinical Director.
Description
Keywords
Research Subject Categories::MEDICINE