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Long-term functional outcome after early surgery compared with laser and medicine in open-angle glaucoma
C Migdal1, W Gregory, R Hitchings
1Moorfields Eye Hospital, London.
Ophthalmology
|October 1, 1994
Summary
Primary trabeculectomy effectively preserves visual function in open-angle glaucoma patients by lowering intraocular pressure. Laser trabeculoplasty also shows promise, while medical therapy demonstrated visual field decay over five years.
Area of Science:
- Ophthalmology
- Glaucoma Research
- Surgical Efficacy
Background:
- Open-angle glaucoma requires effective primary treatment to control intraocular pressure (IOP) and prevent visual field loss.
- Previous treatments for open-angle glaucoma include laser trabeculoplasty, medical therapy, and trabeculectomy, each with varying efficacy.
- No prior antiglaucoma treatment was administered to study participants.
Purpose of the Study:
- To compare the efficacy of laser trabeculoplasty, medical therapy, and trabeculectomy as primary treatments for open-angle glaucoma.
- To assess the impact of each treatment on intraocular pressure control.
- To evaluate the rate of visual field decay across the different treatment groups.
Main Methods:
- A prospective, randomized clinical trial involving 168 patients with open-angle glaucoma.
- Patients were allocated to three groups: laser trabeculoplasty, medical therapy, or trabeculectomy.
- Follow-up extended to a minimum of 5 years, with regular monitoring of intraocular pressure and visual fields using Friedmann analyzer and Humphrey automated perimetry.
Main Results:
- Primary trabeculectomy achieved the lowest mean intraocular pressures compared to laser and medical treatments.
- Visual fields deteriorated in the medical therapy group and, to a lesser extent, in the laser trabeculoplasty group, but remained stable in the trabeculectomy group.
- Multivariate analysis indicated that IOP control at 6 months fully explained the difference in visual field changes between laser and surgical treatments, but not for medical therapy.
Conclusions:
- Primary trabeculectomy is effective in preserving visual function for patients with high-tension open-angle glaucoma.
- Laser trabeculoplasty may offer similar benefits in preserving visual function, potentially linked to IOP reduction.
- Medical therapy was associated with significant visual field deterioration, highlighting the importance of IOP control in glaucoma management.