Long-term Outcome of Trabeculectomy for Juvenile Open-angle Glaucoma in Black Africans: A Tertiary Healthcare Facility Experience in Sub-Saharan Africa

Abstract

Background: Juvenile open-angle glaucoma (JOAG), though a relatively uncommon form of open-angle glaucoma, poses a treatment challenge because of its aggressive nature and management being largely surgical. Purpose: To assess the outcome of trabeculectomy among Black African patients with JOAG. Methods: This was a retrospective audit of the medical records of patients with JOAG who underwent trabeculectomy between 2017 and 2021. One hundred and nineteen eyes of 91 patients were studied. Data retrieved included sociodemographic characteristics, intraocular pressure (IOP) before surgery, the number of preoperative glaucoma medications, postoperative IOPs at different timelines, and early and late complications. Results: The mean age at presentation was 30.2 ± 10.0 years, and there were 56 (61.5%) males. Advanced glaucoma accounted for 96 (80.7%) eyes. Complete success (IOP < 15 mmHg) at 6 months, 2 years, and 5 years was 84.9% ( n = 101 out of 119), 77.3% ( n = 92 out of 119), and 66.7% ( n = 56 out of 87), respectively. Complete success (IOP < 21 mmHg) at 6 months, 2 years, and 5 years was 95.0% ( n = 113 out of 119), 84.9% ( n = 101 out of 119), and 73.6% ( n = 64 out of 87), respectively. The mean IOP decreased from the peak preoperative value of 30.7 ± 12.3 to 12.8 ± 2.5 mmHg at 5 years postoperatively ( P < 0.001). The most common early and late postoperative complications were conjunctival retraction in 13 (10.9%) eyes and cataract formation in 8 (6.7%) eyes, respectively. Conclusion: Our findings demonstrate a high long-term success rate of trabeculectomy in young Africans, supporting its strong recommendation for JOAG management in our setting.