Trabeculectomy without antimetabolite in black African primary open angle glaucoma

Purpose: To assess simple trabeculectomy in black Africans with open angle glaucoma. Methods: We studied retrospectively 80 eyes of 62 patients with primary open angle glaucoma operated by Cairn's trabeculectomy without adjunction of antimetablites. Thirty seven eyes had a limbal-based conjonctival flap and the others 43 had a fornix-based conjonctival flap. Failures and succes were assessed with the Kaplan-Meier's method. Results: Patients were ail seen at least 12 months after surgery. The mean follow up was 24 months. At mid-term survey we found complications to be frequent. Pathological blebs occured in 22.5% (18 cases). The survival probability grew shorter with time. Only 44% of patients were reviewed at 36 months and 29% at 48 months. The succes rate (IOP less than 21 mmHg of all glaucoma medications) varied according to the conjonctival flap. It was respectively at 12 months, 24 months and 36 months: 97%, 70% and 54% with limbal-based flap, and 46%, 18% and 18% with fornix-base flap. The overall rate of tonometric failures was 33.75%. Failures were more often with fornix- based flap (85%). Generally they set in before one year of survey. This was so in 91% of absolute failures and in 87% of relative failures. The failures rate seems to increase with topical polytherapy given more than 12 months before operation. Conclusions: Trabeculectomy with limbal-based conjonctival flap is at mid-term follow up successful in black Africans. However the following up difficulties in Africa makes it a too delicate assessment objective for long-term results of trabeculectomy.