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Angle-closure glaucoma, or closed-angle glaucoma, is an eye condition where the iris bulges out and blocks the iridocorneal angle, resulting in a buildup of aqueous humor and increased intraocular pressure. Immediate medical attention is necessary due to the sudden onset of symptoms. The treatment for angle-closure glaucoma includes short-term and long-term approaches. Short-term treatment involves using eye drops like pilocarpine to lower intraocular pressure by increasing aqueous humor...
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In open-angle glaucoma, the iridocorneal angle remains open, but the trabecular meshwork becomes stiff, slowing down the outflow of aqueous humor. This causes a buildup of aqueous humor in the anterior chamber, leading to a sudden increase in intraocular pressure. The treatment for open-angle glaucoma focuses on reducing the elevated intraocular pressure by either decreasing the secretion of aqueous humor or increasing its outflow.
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Evidence-based medicine in glaucoma surgery.

Yoshiaki Kiuchi1

  • 1Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.

Taiwan Journal of Ophthalmology
|October 12, 2017
PubMed
Summary

Evidence-based medicine (EBM) guides effective treatment. Applying EBM to glaucoma surgery, the Tube Versus Trabeculectomy (TVT) study demonstrated high-level evidence comparing trabeculectomy and Baerveldt implants.

Keywords:
evidence-based medicineglaucomatrabeculectomytube surgery

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Area of Science:

  • Ophthalmology
  • Medical Research Methodology

Background:

  • Evidence-based medicine (EBM) is crucial for effective clinical decision-making.
  • Open-angle glaucoma management often involves surgical interventions like trabeculectomy and Baerveldt implants.

Purpose of the Study:

  • To exemplify the application of EBM in selecting the optimal surgical procedure for open-angle glaucoma.
  • To compare the efficacy of trabeculectomy versus Baerveldt implant surgery using a high-level evidence study.

Main Methods:

  • Formulating answerable clinical questions regarding glaucoma surgery outcomes.
  • Systematic literature search using databases like MEDLINE and Cochrane Library.
  • Evaluation of the Tube Versus Trabeculectomy (TVT) Study, a prospective, randomized multicenter controlled trial.

Main Results:

  • The TVT Study provided high-level evidence for comparing surgical interventions.
  • Quantification of treatment effects, including absolute risk reduction (ARR) and number needed to treat (NNT).
  • Calculation of absolute risk increase (ARI) and number needed to harm (NNH) to assess the likelihood of benefit versus harm.

Conclusions:

  • EBM integrates clinical expertise with the best available external evidence.
  • The methodology allows for quantitative comparison of surgical outcomes in glaucoma treatment.
  • Informed clinical decisions can be made by balancing the potential benefits and harms of different surgical procedures.