title: Current management of glaucoma.
abstract: OBJECTIVE
  This study reviews current concepts in the goals of glaucoma therapy, interventional sequence, and options for the management of glaucoma in light of recent clinical trials.
  
  
  RESULTS
  Recent randomized prospective trials of ocular hypertension and glaucoma have provided evidence for more specific treatment goals in glaucoma therapy. In addition, the advent of the prostaglandin analogs, advances in laser technology, and innovative techniques for filtering surgery have expanded the armamentarium that ophthalmologists use in the treatment of glaucoma.
  
  
  CONCLUSIONS
  Despite continued advances in laser and incisional surgery, medical therapy still appears to be the primary means by which intraocular pressure is controlled. Initial medical therapy has changed with the introduction of prostaglandin analogs, which are replacing beta-antagonists as the drug of first choice. Laser trabeculoplasty, using either photocoagulative (argon and diode) or photodisruptive (frequency doubled Nd:YAG) lasers, is still reserved for patients who do not improve with medical therapy, although there is good evidence that initial laser trabeculoplasty is just as effective as initial medical therapy. Trabeculectomy with antifibrotic agents (5-fluorouracil or mitomycin C) is still the next step in intraocular pressure control, and glaucoma drainage implants are reserved for refractory cases. Cyclophotocoagulation is a last resort procedure because of poor visual outcomes and is reserved for patients with intractable pain and vision thought not to be useful.
authors.affiliation: The Georgetown University Hospital/Washington Hospital Center Washington, DC, USA. twsamuelson@mneye.com
authors.forename: Kenneth
authors.initials: K
authors.lastname: Schwartz
authors.forename: Donald
authors.initials: D
authors.lastname: Budenz
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D003661:Decision Support Techniques; D018463:Filtering Surgery / Q000379:methods; D005901:Glaucoma / Q000628:therapy*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure; D017410:Practice Guidelines as Topic
chemical_list: D000959:Antihypertensive Agents