[Primary trabeculectomy in the surgery of primary open angle glaucoma]

Comparative analysis of the results of trabeculectomy in the surgery of primary open angle glaucoma (POAG) as the primary therapeutical approach and after the medical treatment failure.

Retrospective study including two therapeutical groups: A (59 patients) with primary trabeculectomy; and B (60 patients) with trabeculectomy following a medical treatment failure; mean follow-up period was 3 years and 5 months.

Postoperative drop in intraocular pressure was similar in the two groups; there is no statistical significant difference between the two groups regarding stationary disease (76.27% in group A, versus 73.33% in group B), regressive disease (6.8% versus 6.7% respectively) and progressive disease (18.6% in group A, versus 21.6% in group B). At an intraocular pressure < or = 21 mmHg 13.6% of glaucoma cases do progress. The rate of peroperative and postoperative complications is similar in the two groups.

The prior medical treatment of glaucoma doesn't affect the evolution of operated POAG. Primary trabeculectomy is indicated for non-compliant patients and for patients in whom administration of combined medical treatment for short time periods doesn't lower the intraocular pressure at safe levels. Surgical treatment has the advantage of an important and constant lowering of the intraocular pressure which is an absolute requirement for an efficient control of advanced glaucoma.