The Moorfields Safer Surgery System: preventing glaucoma blindness in the Caribbean

ABSTRACT

Introduction: Glaucoma is the leading cause of blindness in the Caribbean, accounting for 28.4% in Barbados and 32% in Trinidad and Tobago (T&T). In T&T, 28% of glaucoma patients miss clinic appointments and 40% are non-compliant with eye drops. There is a role for surgery in preventing glaucoma blindness. However, the complications of mitomycin C trabeculectomy (MMCT) have deterred local ophthalmologists and patients from selecting this option. The Moorfields Safer Surgery System (MSSS) allows simple modification of surgical technique which can be implemented to improve surgical outcomes. Purpose: To demonstrate the safety and efficacy of the MSSS in the Caribbean. Methods: Thirty-three consecutive MMCT procedures were performed by a single surgeon using the MSSS. Patients were of African descent, 16 male and 8 female. Median age was 56 years (range 34-79 years). Mean pre-operative intraocular pressure (IOP) 23.2 mmHg. In 38%, best-corrected visual acuity (BCVA) was ≤3/60 in at least one eye. Results. IOP was ≤21 mmHg in 92.6% of patients at 1 year and in 87.5% at 5 years. Removal of scleral releasable suture(s) was required in 85%, 5-fluorouracil injection(s) in 85% and bleb needling in 36%. The most common complication was early bleb leak (52%). 91% had excellent or satisfactory bleb morphology. No patient developed endophthalmitis. 73% had equal or better BCVA in the operated eye. Conclusion: Glaucoma in the African Caribbean population is an aggressive disease which affects young adults. Late presentation and non-adherence to topical treatment favour surgical intervention. This study provides evidence that knowledge and skills transfer of the MSSS to the Caribbean is possible. Surgical success and complication rates comparable to best published international data can be achieved.