Surgical vs medical management of chronic open-angle glaucoma.
OBJECTIVE
We studied patients with chronic open-angle glaucoma who had similar intraocular pressures to determine whether surgical or medical therapy is more effective in preventing progressive, long-term, glaucomatous damage.


METHODS
Included in this study were patients with chronic open-angle glaucoma who were followed for 3 years or longer and were treated, through either medical or surgical therapy, by adjusting intraocular pressure to 18 mm Hg or less as a therapeutic end point. We studied 31 matched pairs of patients in which one member was treated by surgery and one member had medical treatment. In every pair, we matched each patient individually by age, race, and intraocular pressure.


RESULTS
For the matched pairs of patients in this study, the mean intraocular pressure following initiation of treatment was 13.5 and 13.1 mm Hg for the surgically and medically treated groups, respectively (P = .475). This study found no difference between groups in the incidence of glaucomatous progression following surgical (n = 3) or medical (n = 3) therapy (P > .99, McNemar's test) for an average follow-up of 40.0 +/- 10.0 and 43.4 +/- 8.4 months in the medical and surgical groups respectively. The glaucoma of three patients progressed on the basis of reduced visual acuity, two by visual field, and one by disk hemorrhage. Although the types of complications from therapy differed between groups, no vision loss or life-threatening events occurred directly from these treatments.


CONCLUSIONS
When intraocular pressure is used as a therapeutic end point, both filtration surgery and medical therapy appear to be equally effective in maintaining long-term visual function and a stable optic disk in chronic open-angle glaucoma.
Stewart
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WC
Pharmaceutical Research Corporation, Charleston, South Carolina 29412-2464, USA.
Sine
C S
CS
LoPresto
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C
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D002257:Carbonic Anhydrase Inhibitors / Q000627:therapeutic use*; D002908:Chronic Disease; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D008916:Miotics / Q000627:therapeutic use*; D018918:Phacoemulsification; D014130:Trabeculectomy; D014792:Visual Acuity
D000316:Adrenergic alpha-Agonists; D000319:Adrenergic beta-Antagonists; D002257:Carbonic Anhydrase Inhibitors; D008916:Miotics; D004837:Epinephrine