title: A study of initial therapy for glaucoma in southern India: India Glaucoma Outcomes and Treatment (INGOT) Study.
abstract: OBJECTIVE
  To compare initial glaucoma therapy with medications and trabeculectomy in southern India.
  
  
  METHODS
  Patients aged ≥ 30 years newly diagnosed with glaucoma were randomized to trabeculectomy with 5-fluorouracil or medical therapy. Subjects with best-corrected vision <6/18 due to cataract underwent phacoemulsification (phaco/intraocular lens, IOL). Intraocular pressure (IOP), vision and visual function were assessed at 12 months.
  
  
  RESULTS
  Patients assigned to medications and surgery received the expected therapy in 86% (172/199) and 64% (126/199) of cases, respectively. Forty patients (20%) assigned to surgery refused any treatment and 33 (17%) received medications. Among 199 patients randomized to medications, 52 (26.1%) underwent phaco/IOL, as did 89/199 (43.7%) of patients randomized to trabeculectomy. Baseline parameters of the two groups did not differ, nor did 1-year follow-up rates (medication 65%, trabeculectomy 58%, P = 0.15). Final IOP was lower with randomization to trabeculectomy (16.3 ± 5.1 mmHg) than medication (18.8 ± 6.7 mmHg, P < 0.0001). In regression models, randomization to trabeculectomy (P < 0.0001) was associated with lower IOP, and simultaneous trabeculectomy and cataract surgery was associated with higher IOP (P = 0.008) than trabeculectomy alone. Subjects receiving Phaco/IOL had significantly better final acuity (P < 0.0001) and visual function (P = 0.035), despite concurrent glaucoma treatment. Final visual acuity was worse in those receiving trabeculectomy in addition to cataract surgery, but this was of borderline significance (P = 0.06).
  
  
  CONCLUSIONS
  Trabeculectomy lowered IOP significantly more than medical treatment, but with slightly greater loss of visual acuity. Combined phaco/IOL and trabeculectomy improved visual acuity with substantial IOP lowering.
authors.affiliation: Zhongshan Ophthalmic Center, State Key Laboratory and Division of Preventive Ophthalmology, Sun Yat Sen University, Guangzhou, PRC. ncongdon1@gmail.com
authors.forename: Nathan G
authors.initials: NG
authors.lastname: Congdon
authors.forename: R
authors.initials: R
authors.lastname: Krishnadas
authors.forename: David S
authors.initials: DS
authors.lastname: Friedman
authors.forename: William
authors.initials: W
authors.lastname: Goggins
authors.forename: R
authors.initials: R
authors.lastname: Ramakrishnan
authors.forename: M A
authors.initials: MA
authors.lastname: Kader
authors.forename: Donna
authors.initials: D
authors.lastname: Gilbert
authors.forename: James
authors.initials: J
authors.lastname: Tielsch
authors.forename: Harry A
authors.initials: HA
authors.lastname: Quigley
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000068438:Brimonidine Tartrate; D004338:Drug Combinations; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005901:Glaucoma / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007194:India; D007429:Intraocular Pressure / Q000502:physiology; D000077338:Latanoprost; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011446:Prospective Studies; D011461:Prostaglandins F, Synthetic / Q000627:therapeutic use; D011810:Quinoxalines / Q000627:therapeutic use; D013449:Sulfonamides / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D013876:Thiophenes / Q000627:therapeutic use; D013999:Timolol / Q000627:therapeutic use; D014065:Tonometry, Ocular; D014130:Trabeculectomy; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000959:Antihypertensive Agents; D000964:Antimetabolites, Antineoplastic; D004338:Drug Combinations; D011461:Prostaglandins F, Synthetic; D011810:Quinoxalines; D013449:Sulfonamides; D013876:Thiophenes; C479140:dorzolamide-timolol combination; D000068438:Brimonidine Tartrate; D000077338:Latanoprost; D013999:Timolol; D005472:Fluorouracil