Outcomes of combined cataract and trabeculectomy surgery in Kenya: A multicenter retrospective case series study

Abstract

Background: Globally, cataracts and glaucoma are the leading causes of blindness accounting for 43% and 12% of the total cases respectively. In developing countries, glaucoma is generally diagnosed at an advanced stage, only when the patient seeks advice for cataract surgery. This study aimed to evaluate the outcome of combined trabeculectomy and cataract surgery in terms of intraocular pressure, visual acuity, associated complications, and clinically relevant factors that are associated with a poor outcome.

Methods: Hospital-based, retrospective case series. Patients who underwent combined cataract and glaucoma surgery at Kisii Eye Hospital, Tenwek Mission Hospital and the Kenyatta National Hospital from January 2012 to December 2016 were included. Data was collected using a questionnaire and analysed using SPSS version 23. Descriptive analysis was done to determine the means, frequencies and proportions of the various variables. Chi-square was used to test association; confidence level was taken as 95% (p <0.05) where applicable.

Results:  Majority of the patients did not have sustained pressure control, especially for the subgroups of patients with longer follow-ups. Over sixty-two per cent of those who returned for 4 – 8 weeks of follow-up achieved an improvement in visual acuity and nearly 21% achieved 6/18 or better. Acute postoperative complications included corneal edema, flat bleb, and encapsulated bleb among others. Different age groupings were found to be a significant risk factor for poor visual outcomes in patients who underwent combined surgery. There was no statistically significant difference in baseline characteristics and mean IOP between phaco-trab and small incision cataract surgery with trabeculectomy (SICST) surgery groups except for LogMAR visual acuity (p = 0.015).

Conclusion: Poor follow-up limited the precision of the findings but also means that a ‘one-stop’ operation for glaucoma and cataracts may be a viable and practical approach to management.