Sir,

In the late 1990s and early 2000s a dramatic decline in the rate of trabeculectomy was observed; for example, a UK study reported a reduction in admissions for trabeculectomy from a peak of 38.7 per 100 000 population in 1995 to 10.6 per 100 000 in 2004.1, 2, 3 The decrease in surgery was attributed primarily to the introduction of new ocular hypotensive medications.

We recently examined the trabeculectomy rates in our area. Patients who had undergone trabeculectomy at Leicester Royal Infirmary between 1 January 1998 and 31 December 2009 were identified from two sources; clinical coding records (searching for OPCS code C60.1) and the surgical logbook.

In common with the experience elsewhere the number of trabeculectomies performed in our unit declined by 73.7% between 1998 and 2005; however, from 2005 to 2009 there was a 149.3% increase in trabeculectomies (Figure 1). We calculated the trabeculectomy rate based on the Office of National Statistics 2003 mid-year population estimate for Leicestershire and Rutland of 938 013 (Table 1). The trabeculectomy rate declined from 28.78 per 100 000 in 1998 to 7.57 in 2005 but increased to 18.87 per 100 000 in 2009.

Figure 1
figure 1

Trends in trabeculectomies from 1998 to 2009.

Full size image
Table 1 Number of trabeculectomies and trabeculectomy rate for Leicester, Leicestershire and Rutland from 1998–2009
Full size table

Our observations are the first to suggest that the decline in trabeculectomy has now stopped and may have begun to reverse. Reasons for an increase in trabeculectomy are likely to include recent improvements in surgical techniques, which have led to a reduction in perioperative complications and better outcome.4 Some patients may have avoided surgery a few years ago, as new medications were tried, only to later develop disease progression or medication intolerance. New medications may have delayed the patient's journey to surgery but not prevented it. There may now also be increased recognition of the need for low target intraocular pressures not always achievable with medication.

We acknowledge that this study is limited to one unit and so may not reflect national or international trends; however, the trabeculectomy rates calculated for Leicestershire and Rutland between 1998 and 2004 closely mirror previously reported national figures.1 An increase in trabeculectomy rate would have important implications for future health-care planning and resource allocation.