Surgical management of primary open-angle glaucoma in Central China: A 6-year retrospective cohort study

Abstract

This study aims to describe the epidemiology, clinical and social characteristics, management, and outcomes of patients with primary open-angle glaucoma in Henan of Central China. A total of 610 glaucoma cases (744 eyes) from 2017 to 2023 were included in the analysis. The study analyzed general information including age, sex, occupation, medical insurance and level of education. The patient's medical history, including glaucoma family history, associated systemic diseases, and the number and name of glaucoma medications were also analyzed. The analysis also included intraocular pressure (IOP), cup/disc area ratio (C/D), surgical options, and postoperative follow-up results. Prior to their visit to Henan Eye Hospital, 607 eyes (81.56%) from 2017 to 2023 have been treated with antiglaucoma medications, with prostaglandin derivatives being the most commonly prescribed drugs. The New Rural Cooperative Medical System (NCMS) provided substantial reimbursement (50.67%) for primary open-angle glaucoma-related medical expenses. Notably, a significant proportion of patients identified their occupation as "farmer" (39.97%). The most common symptoms included blurred vision (36.75%). While common clinical signs consisted of elevated IOP (70.97%) and enlargement of the C/D ratio (87.48%). Regarding surgical procedures, non-penetrating trabeculectomy was the most frequently performed procedure (32.01%). Additionally, there was an observed increasing trend in the use of microcatheter-assisted 360° trabeculotomy (MAT) combined trabeculectomy over the years. Mean IOP ± standard deviation decreased from 28.24 ± 11.43 mm Hg before surgery to 15.39 ± 6.42 mm Hg at the final follow-up (P < .001). Average of superior retinal nerve fiber lay, ganglion cell complex, and superior ganglion cell complex thickness were significantly reduced compared to their preoperative levels. The findings of this study highlight the importance of improving NCMS coverage and promoting education in the region to enhance glaucoma care and management. Additionally, regular optical coherence tomography examination are recommended for early detection and follow-up of glaucoma treatment.

Keywords: GCC; IOP; POAG; RNFL; epidemiology.

Figure 1.

The line chart of the percentage of different types of surgery was drawn by time as a unit (year). The blue, red, and gray lines indicate surgical modalities of the non-penetrating trabeculectomy, trabeculectomy and MAT combined trabeculectomy, respectively. After 2019 year, MAT combined Trab had been gradually carried out in our medical center. The proportion of non-penetrating trabeculectomy, trabeculectomy and MAT combined Trab was 41.05%, 23.16%, and 16.84% in 2019 year. In 2020 year, the proportion was 31.34%, 29.10%, and 20.15%, respectively. In 2021 year, the proportion was 12.93%, 40.14%, and 26.53%, respectively. In 2022 year, the proportion of non-penetrating trabeculectomy, trabeculectomy and MAT combined Trab was 15.57%, 26.63%, and 32.66%, respectively. MAT = microcatheter-assisted 360 trabeculotomy.