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Original Investigation
October 2016

Interventions to Promote Follow-up After Trabeculectomy Surgery in Rural Southern ChinaA Randomized Clinical Trial

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. 2016;134(10):1135-1141. doi:10.1001/jamaophthalmol.2016.2819
Key Points

Question  Can free medications and text message reminders improve adherence to follow-up after glaucoma surgery in rural China?

Findings  This randomized clinical trial of 209 patients found that text message reminders significantly improved postoperative follow-up at 1 month. In addition, being told to return for suture removal had a further impact, with increased return rates among individuals requiring suture removal.

Meaning  Low-cost interventions may improve postoperative follow-up significantly after glaucoma surgery in rural China, providing opportunities for interventions to improve surgical success.


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