[Treatment of chronic primary open-angle glaucoma. Long-term functional results]

The functional results of the treatment of primary open angle glaucoma (POAG) were analysed. A retrospective study was undertaken on 437 eyes from 282 patients (137 women, 145 men) followed in Saint Joseph's Hospital (Paris). The mean follow-up was 9.7 years (4-22 years). 265 eyes received only medical treatment, 83 eyes argon laser trabeculoplasty (ALT) and 89 eyes surgery (66 trabeculectomies - 23 cataract-glaucoma combined operations). At least twice a year, intraocular pressure (IOP), visual acuity (VA) and mean total visual capability (TVC) on the Friedmann analyser were recorded on a computer. The severity gradient (SG) was calculated from the evolution gradient of TVC versus IOP with time for each group (medical, ALT, surgery) before and after treatment. Medical SG was not significantly different from ALT SG or surgery SG (trabeculectomy or combined surgery). For each group, SG before treatment was not significantly different from SG after treatment. For tonometric failures after ALT or surgery, SG before treatment was not different from SG after treatment. Nevertheless, after trabeculectomy, in the cases of clear tonometric success (IOP less than or equal to 16 mmHg), SG was significantly improved (p less than 0.001). On the other hand, no positive influence was noted on visual field evolution in cases of a commonly admitted good tonometric control (IOP less than or equal to 21 mmHg). Visual acuity loss after trabeculectomy was greatest during the first year (6/20). The cataractogenic role of trabeculectomy was statistically confirmed. The incidence of cataract at 5 years was 46%. This cataractogenic effect occurred significantly more after 55 years. We discuss tonometric effect on TVC evolution.(ABSTRACT TRUNCATED AT 250 WORDS)