Primary argon laser trabeculoplasty vs pilocarpine. III. Long-term effects on visual fields

Area of Science:

• Ophthalmology
• Glaucoma Research
• Laser Therapy

Background:

• Open-angle glaucoma is a leading cause of irreversible blindness.
• Primary medical treatment with pilocarpine has limitations in long-term efficacy.
• Laser trabeculoplasty offers a potential alternative primary therapy.

Purpose of the Study:

• To compare the efficacy of primary argon laser trabeculoplasty versus pilocarpine in newly detected open-angle glaucoma.
• To analyze visual field changes over two years in both treatment groups.
• To determine the optimal primary treatment strategy for different glaucoma subtypes.

Main Methods:

• Prospective randomized study involving 82 patients with newly detected open-angle glaucoma.
• Visual field changes assessed using automated threshold perimetry and manual Goldmann perimetry over 2 years.
• Regression analysis performed on monthly automated perimetry data, with corrections for cataract and miosis.

Main Results:

• Significantly less visual field decay observed in the laser trabeculoplasty group compared to the pilocarpine group.
• The beneficial effect of laser trabeculoplasty was more pronounced in patients with capsular glaucoma, particularly in early stages.
• No significant advantage of laser therapy was found in the smaller subgroup with simple glaucoma.
• Successful reduction of intraocular pressure correlated with improved visual field outcomes in both groups.

Conclusions:

• Argon laser trabeculoplasty is recommended as a primary therapy for capsular glaucoma.
• Laser trabeculoplasty demonstrates superior visual field preservation compared to pilocarpine in open-angle glaucoma.
• Intraocular pressure control is a critical factor for visual field preservation in glaucoma management.