Medical versus surgical interventions for open angle glaucoma

Burr, Jennifer; Azuara‐Blanco, Augusto; Avenell, Alison; Tuulonen, Anja

doi:10.1002/14651858.cd004399.pub3

Cited by 148 publications

(121 citation statements)

References 70 publications

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“…NICE guidelines have recommended that patients who present with advanced glaucoma should be offered primary glaucoma surgery. 10 A recent systematic review comparing primary medical vs surgical treatment for glaucoma 11 concluded that further randomised controlled trials of current medical treatments compared with surgery are required in people with advanced glaucoma. 11 A randomised, prospective clinical trial, comparing primary medical with primary surgical treatment in patients presenting with advanced glaucoma is thus warranted.…”

Section: Introductionmentioning

confidence: 99%

The willingness of patients presenting with advanced glaucoma to participate in a trial comparing primary medical vs primary surgical treatment

Leighton

Lonsdale

Tildsley

et al. 2011

Eye

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Aim The aim of this study is to examine the attitudes of patients, who presented with advanced glaucoma in at least one eye, to participation in a randomised prospective trial comparing primary medical treatment with primary surgical treatment for advanced glaucoma. Methods Patients who had presented with advanced glaucoma (415 dB loss mean deviation on Humphrey visual field testing) in at least one eye were asked to participate. Five focus groups comprising of 4-8 patients and consisting of 29 patients in total were undertaken. The group interviews were conducted by two experienced qualitative researchers, an ophthalmic clinician was present to clarify technical issues. The focus group discussions were taped and transcribed in full, and analysed through a process of familiarisation, open (inductive) coding, theme generation, theme refinement, and thematic mapping. Results Three overarching themes were identified: (1) the extent of patients' knowledge, (2) anxieties about surgery, and (3) concerns about compromised care due to trial involvement; these themes were further classified into eight sub-themes. Conclusions Patients' willingness to participate in randomised clinical studies is significantly connected to their level of comprehension and insight about the medical condition, its treatment, and the research process; misunderstandings about any of these aspects may act as a significant barrier to trial recruitment. Recruitment rates for future randomised trials may be enhanced by ensuring that patients have full and accurate information about the treatment alternatives, and that uncertainty exists for best patient outcomes between treatment options, and reassuring potential participants that the research process, in particular randomisation, will not compromise clinical care.

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Section: Introductionmentioning

confidence: 99%

The willingness of patients presenting with advanced glaucoma to participate in a trial comparing primary medical vs primary surgical treatment

Leighton

Lonsdale

Tildsley

et al. 2011

Eye

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“…In a recent Cochrane study, Burr et al (2) reviewed the findings of four randomized controlled trials that had compared medical therapy and trabeculectomy in adults with open-angle glaucoma (n=888). In corroboration with the findings of the present study, they concluded that primary trabeculectomy is superior to primary medical therapy in decreasing IOP.…”

Section: Discussionmentioning

confidence: 99%

“…The exact rate in eyes with medical therapy, however, is unknown. As mentioned above, there is currently a lack of sufficient data from recent studies of newer medications and surgical techniques for glaucoma (2) , with many previous reports using flawed methodologies (5) and varying follow-up periods as well as employing different criteria to define success (6) , potentially underlying the heterogeneity in reported results. Although the efficacy of medical therapy and trabeculectomy in achieving endpoint desirable IOP did not differ significantly in the present study, the rate of failure in the medical group, i.e., the number of cases that eventually needed trabeculectomy, was still high (34%).…”

Section: Discussionmentioning

confidence: 99%

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Medical therapy versus trabeculectomy in patients with open-angle glaucoma

Motlagh

2016

Arquivos Brasileiros De Oftalmologia

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Purpose: To compare therapeutic outcomes between trabeculectomy and medical therapy in patients with open-angle glaucoma. Methods: In the present retrospective comparative study, the medical charts of 284 patients (eyes) newly diagnosed with open-angle glaucoma who had received conventional medications (n=188) or undergone fornix-based trabeculectomy (n=96) at a teaching eye hospital were reviewed. Results: At a mean follow-up of 6.6 years, post-treatment changes in intraocular pressure (IOP), visual field (VF), best spectacle-corrected visual acuity (BSCVA), and number of required drugs were significantly more favorable in the surgical group (P<0.001 for all comparisons). However, the frequency of clinically desirable IOP (≤21 mmHg) at the endpoint was comparable between the surgical and medical groups (87.2% vs. 82.3%; P=0.26). The rate of conversion to surgical therapy was 34% in the medical group. A greater baseline requirement for anti-glaucoma drugs (two or more) was the only independent predictor of treatment failure in the present study. Conclusions: Although more severe cases naturally receive trabeculectomy, the surgical approach had greater efficacy than conventional medical therapy in patients with open-angle glaucoma. An initial requirement for two or more anti-glaucoma drugs may predict failure of medical therapy.

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“…There is some evidence that surgical intervention lowers IOP more effectively, but surgery is also associated with more complications (Burr et al. 2012), and thus it is relevant to search for more efficient strategies for reducing IOP that can help avoid having to resort to surgery. To our knowledge, no studies focused on IOP reduction have compared the conventional approach of stepwise treatment escalation with a more radical non‐surgical approach such as that used in the GITS.…”

Section: Introductionmentioning

confidence: 99%

Initial intraocular pressure reduction by mono‐ versus multi‐therapy in patients with open‐angle glaucoma: results from the Glaucoma Intensive Treatment Study

Lindén

Heijl

Jóhannesson

et al. 2018

Acta Ophthalmologica

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PurposeTo study newly diagnosed glaucoma patients given mono‐ or multi‐therapy regarding differences in initial intraocular pressure (IOP) reduction, target IOP levels reached and influence of untreated baseline IOP on IOP reduction.MethodsPatients newly diagnosed with manifest primary open‐angle glaucoma and included in the Glaucoma Intensive Treatment Study (GITS) were randomized to immediate intensive treatment with any of three different IOP‐lowering substances supplied in two bottles plus 360° laser trabeculoplasty or to conventional stepwise treatment starting with a single‐drug. Intraocular pressure reduction was analysed 1 month after initiation of treatment.ResultsOne hundred eighteen patients (143 eyes) received mono‐therapy and 122 patients (152 eyes) multi‐therapy. Median baseline IOP was 24.0 (min: 9.7, max: 56.0) mmHg in mono‐therapy eyes and 24.0 (min: 12.3, max: 48.5) mmHg in multi‐therapy eyes (p = 0.56). After 1 month in the two groups, respectively, values for median IOP reduction were 6.3 (range: −5.3–31.0) and 11.0 (range: 0.7–34.5) mmHg, and for mean relative decline 26.8 (range: −32.0–55.4) and 46.0 (range: 4.6–81.6) % (p = 0.000). A larger proportion of the multi‐therapy patients reached each target IOP level (p = 0.000). The higher the baseline IOP, the larger the observed pressure reduction, considering both absolute and relative figures. The effect was more pronounced in eyes with multi‐therapy than in those with mono‐therapy (p = 0.000). For every mmHg higher IOP at baseline, the IOP was reduced by an additional 0.56 (mono‐therapy) or 0.84 (multi‐therapy) mmHg.ConclusionIntensive treatment led to considerably greater IOP reduction than mono‐therapy. Among patients with IOP ≥30 mmHg at diagnosis an IOP of <16 was reached in 2/3 of those with multi‐therapy but in none with mono‐therapy. The IOP reduction was highly dependent on the untreated IOP level.

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Medical versus surgical interventions for open angle glaucoma

Cited by 148 publications

References 70 publications

The willingness of patients presenting with advanced glaucoma to participate in a trial comparing primary medical vs primary surgical treatment

The willingness of patients presenting with advanced glaucoma to participate in a trial comparing primary medical vs primary surgical treatment

Medical therapy versus trabeculectomy in patients with open-angle glaucoma

Initial intraocular pressure reduction by mono‐ versus multi‐therapy in patients with open‐angle glaucoma: results from the Glaucoma Intensive Treatment Study

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