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Primary trabeculectomy versus primary glaucoma eye drops for newly diagnosed advanced glaucoma: TAGS RCT.
Anthony J King1, Gordon Fernie2, Jemma Hudson2
1Department of Ophthalmology, Nottingham University Hospital, Nottingham, UK.
Health Technology Assessment (Winchester, England)
|December 2, 2021
Summary
For advanced open-angle glaucoma, augmented trabeculectomy offers better intraocular pressure control than medical management, with similar quality of life and potential long-term cost-effectiveness.
Area of Science:
- Ophthalmology
- Glaucoma Research
- Surgical Interventions
Background:
- Advanced primary open-angle glaucoma (POAG) poses a significant risk of blindness.
- Uncertainty exists regarding the optimal initial treatment: medical management (glaucoma eye drops) versus surgical treatment (augmented trabeculectomy).
Purpose of the Study:
- To compare primary medical management with primary surgical treatment (augmented trabeculectomy) in advanced POAG.
- Evaluate differences in health-related quality of life, clinical effectiveness, safety, and cost-effectiveness.
Main Methods:
- A pragmatic, multicentre, randomised controlled trial involving 453 adult patients with advanced POAG.
- Two arms: escalating medical management with eye drops versus trabeculectomy augmented with mitomycin C.
- Primary outcome: health-related quality of life (Visual Function Questionnaire-25) at 2 years.
Main Results:
- No significant difference in health-related quality of life (Visual Function Questionnaire-25) between groups at 24 months.
- Trabeculectomy arm demonstrated significantly lower intraocular pressure (12.40 mmHg vs. 15.07 mmHg).
- Trabeculectomy required fewer glaucoma eye drops; medical management showed slightly better LogMAR visual acuity.
Conclusions:
- Augmented trabeculectomy provides superior intraocular pressure control compared to medical management in advanced POAG, without compromising quality of life at 2 years.
- Long-term modeling suggests trabeculectomy may be cost-effective, with a higher probability of being cost-effective at willingness-to-pay thresholds.
- Further follow-up is needed to assess long-term disease progression and cost-effectiveness.
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