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 whet her there has been an associated change in trabeculectomy rates in England over this period. Methods Figures for the total number of trabeculectomies and cataract opera tions performed in England for each year from 1989/90 to 1999/2000 were obt ained from the Department of Health, Hospital Episode Statistics Division. Results The available data show that the number of trabeculectomies and cat aract operations increased year on year from 1990/91 until 1995/96. Since t hen, 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 hav e been delayed or prevented. We postulate that several factors underlie thi s trend and that there are a number of implications regarding the future ma nagement of glaucoma patients.