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Preoperative characteristics and compliance with follow-up after trabeculectomy surgery in rural southern China
  1. Ke Yang1,2,
  2. Ling Jin1,
  3. Li Li2,
  4. Siming Zeng2,
  5. Aihua Dan3,
  6. Tingting Chen1,
  7. Xiuqin Wang1,4,
  8. Guirong Li2,
  9. Nathan Congdon1,5,6
  1. 1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
  2. 2Department of Ophthalmology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
  3. 3Red Cross Hospital of Yunnan Province, Kunming, China
  4. 4Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
  5. 5ORBIS International, New York, USA
  6. 6Queen's University Belfast, Belfast, UK
  1. Correspondence to Professor Nathan Congdon, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangzhou 510060, China, or TREE Centre, Centre for Public Health, Queen's University Belfast, Belfast BT12 6AB, UK; ncongdon1{at}gmail.com

Abstract

Purpose To evaluate preoperative characteristics and follow-up in rural China after trabeculectomy, the primary treatment for glaucoma there.

Methods Patients undergoing trabeculectomy at 14 rural hospitals in Guangdong and Guangxi Provinces and their doctors completed questionnaires concerning clinical and sociodemographic information, transportation, and knowledge and attitudes about glaucoma. Follow-up after surgery was assessed as cumulative score (1 week: 10 points, 2 weeks: 7 points, 1 month: 5 points).

Results Among 212 eligible patients, mean preoperative presenting acuity in the operative eye was 6/120, with 61.3% (n=130) blind (≤6/60). Follow-up rates were 60.8% (129/212), 75.9% (161/212) and 26.9% (57/212) at 1 week, 2 weeks and 1 month, respectively. Patient predictors of poor follow-up included elementary education or less (OR=0.37, 95% CI 0.20 to 0.70, p=0.002), believing follow-up was not important (OR=0.62, 95% CI 0.41 to 0.94, p=0.02), lack of an accompanying person (OR=0.14, 95% CI 0.07 to 0.29, p<0.001), family annual income <US$800 (OR=0.28, 95% CI 0.11 to 0.72, p=0.008) and not requiring removal of scleral flap sutures postoperatively (OR=0.11, 95% CI 0.06 to 0.22, p<0.001). Age, sex, employment, travel distance/time/costs, patient preoperative clinical factors and physician factors were unassociated with follow-up.

Conclusions Follow-up after 2 weeks was inadequate to provide optimal clinical care, and surgery is being applied too late to avoid blindness in the majority of patients. Earlier surgery, support for return visits and better explanations of the importance of follow-up are needed. Directing all patients to return for possible scleral flap suture removal may be a valid strategy to improve follow-up.

  • Glaucoma
  • Epidemiology

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Footnotes

  • Contributors NC contributed in the form of designing, data analysis, manuscript preparation and submission. KY contributed to the collection of data, analysis of results and drafting of manuscript. LJ contributed to the data analysis. LL, SZ, AD, TC, XW  and GL contributed to the collection of data.

  • Funding Financial support was provided by Orbis International, Zhongshan Ophthalmic Center and the World Diabetes Foundation. NC is supported by the Chinese Government Thousand Man Plan and by the Ulverscroft Foundation.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Zhongshan Ophthalmic Center Ethics Committee, Sun Yat-sen University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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