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Original Investigation |

Interventions to Promote Follow-up After Trabeculectomy Surgery in Rural Southern China A Randomized Clinical Trial ONLINE FIRST

Ke Yang, MD1,2; Ling Jin, MS1; Li Li, MD2; Siming Zeng, MD2; Ruqian Wei, MD3; Guirong Li, MD2; Pingyi Man, MD2; Nathan Congdon, MD, MPH1,4,5
[+] Author Affiliations
1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
2People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
3Yizhou Hospital of Traditional Chinese Medicine, Yizhou, China
4ORBIS International, New York, New York
5TREE Centre, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
JAMA Ophthalmol. Published online August 18, 2016. doi:10.1001/jamaophthalmol.2016.2819
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Importance  Follow-up after trabeculectomy surgery is important to surgical success, but little is known about the effect of interventions on improving follow-up in low-resource areas.

Objective  To examine whether text message reminders and free eye medications improve follow-up after trabeculectomy in rural southern China.

Design, Setting, and Participants  This randomized clinical trial studied 222 consecutive patients undergoing trabeculectomy from October 1, 2014, through November 31, 2015, at 4 rural hospitals in Guangdong and Guangxi Provinces, China. Data from the intention-to-treat population were analyzed.

Interventions  Patients undergoing trabeculectomy were randomized (1:1) to receive text message reminders 3 days before appointments at 1 and 2 weeks and 1 month after surgery and free topical corticosteroid medication (US$5.30) at each visit or to standard follow-up without reminders or free medication.

Main Outcomes and Measure  Follow-up at 1 month postoperatively.

Results  Among 222 eligible patients, 13 (5.9%) refused and 209 (94.1%) were enrolled, with 106 (50.7%) randomized to the intervention group (mean [SD] age, 64.4 [12.7] years; 56 women [52.8%]) and 103 (49.3%) to the control group (mean [SD] age, 63.0 [12.7] years; 53 women [51.5%]). A total of 6 patients (2.9%) were unavailable for follow-up. Attendance at 1 month for the intervention group (59 of 102 [57.8%]) was significantly higher than for the control group (34 of 101 [33.7%]) (unadjusted relative risk [RR], 1.72; 95% CI, 1.13-2.63; P = .01). Factors associated with 1-month attendance in multiple regression models included intervention group membership (RR, 1.65; 95% CI, 1.08-2.53; P = .02) and being told to return for suture removal (RR, 1.80; 95% CI, 1.06-3.06; P = .03). One-month attendance among controls not told about suture removal was 3 of 31 (9.7%), whereas it was 44 of 68 (64.7%) among the intervention group with suture removal (unadjusted RR, 6.69; 95% CI, 2.08-21.6; P = .001).

Conclusions and Relevance  In this setting, low-cost interventions may significantly improve postoperative follow-up after glaucoma surgery, a potential opportunity for interventions known to improve surgical success.

Trial Registration  clinicaltrials.gov Identifier: NCT02328456

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Enrollment of Patients in a Trial of Interventions to Improve Follow-up After Glaucoma Surgery
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