Is the role of trabeculectomy in glaucoma management changing

Background In recent years there have been significant developments in the diagnosis and treatment of glaucoma. We conducted a study to determine whether there has been an associated change in trabeculectomy rates in England over this period. Methods Figures for the total number of trabeculectomies and cataract operations performed in England for each year from 1989/ 90 to 1999/2000 were obtained from the Department of Health, Hospital Episode Statistics Division. Results The available data show that the number of trabeculectomies and cataract operations increased year on year from 1990/91 until 1995/96. Since then, the number of cataract procedures has continued to rise dramatically, whereas the number of trabeculectomies has fallen progressively by 7%, 23%, 37% and 53% in the last 4 years. Conclusion The perceived need for surgical intervention would appear to have been delayed or prevented. We postulate that several factors underlie this trend and that there are a number of implications regarding the future management of glaucoma patients.