Reducing intraocular pressure: is surgery better than drugs?

Shaarawy, Tarek; Haefliger, Ivan O.

doi:10.1038/sj.eye.6701374

Cited by 20 publications

(3 citation statements)

References 94 publications

(97 reference statements)

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“…Shaarawy et al 51 have concluded that these observations constitute a definite advantage of surgery over medical treatment. This is supported by the work of Asrani et al 52 who measured diurnal IOP fluctuation using home tonometry and concluded that diurnal fluctuations contributed to visual field progression.…”

Section: Evidence For Better Outcomes For Surgical or Medical Treatmentsmentioning

confidence: 98%

Treating patients presenting with advanced glaucoma--should we reconsider current practice?

King

Stead

Rotchford

2010

British Journal of Ophthalmology

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The management of patients presenting with advanced glaucoma presents a challenge to glaucoma clinicians. Presentation with advanced visual field loss is an important risk factor for progression to blindness in the affected eye(s) during the patients' lifetime. Maximising intraocular pressure (IOP) control in such situations is likely to minimise the risk of further visual field deterioration thus either preventing or slowing progression to blindness. Currently most patients presenting with advanced disease in the UK are managed on an escalating regime of medical treatment. Should this fail glaucoma surgery is usually employed to further lower IOP. Although glaucoma surgery is generally a safe and successful intervention it carries a small risk of severe visual loss and is considered by many clinicians as an intervention only to be used following failure of medical treatment. Recently however the National Institute for Clinical Excellence has suggested in its clinical guidelines for management of ocular hypertension and glaucoma that primary surgery should be offered to patients presenting with advanced glaucomatous visual field loss. This is contrary to the practice of most UK ophthalmologists. In this review the current available evidence underlying the management of presentation with advanced disease is examined.

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Section: Evidence For Better Outcomes For Surgical or Medical Treatmentsmentioning

confidence: 98%

Treating patients presenting with advanced glaucoma--should we reconsider current practice?

King

Stead

Rotchford

2010

British Journal of Ophthalmology

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“…Successful glaucoma surgery may be associated with complete or partial suspension of IOP-lowering medications, hence ameliorating ocular surface homeostasis and reducing medicaments-related DED [ 17 ]. Nonetheless, surgery may induce changes for two main reasons: the use of mitomycin C can cause epithelial damage and goblet cell loss [ 18 ]; filtrating bleb also modifies the anatomy of the ocular surface and may induce DED by itself [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Inter-Eye Comparison of the Ocular Surface of Glaucoma Patients Receiving Surgical and Medical Treatments

Romano

Ruvo

Fogagnolo

et al. 2022

JCM

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Background: Ocular surface frequently affects glaucoma patients. In this paper we aimed at evaluating the impact of glaucoma surgery on the ocular surface of patients who received unilateral trabeculectomy. Methods: 26 consecutive patients successfully treated with trabeculectomy on one eye (Trab Eye) and under control with topical treatments on the fellow eye (Med Eye) were included in this observational study. They received IDEEL and OSDI questionnaires, Tear Film Osmolarity (TFO), grading of conjunctival hyperemia, fluorescein tear break-up time (tBUT), grading of corneal staining and Schirmer test. Results: IDEEL and OSDI scores were 48 ± 38 and 11 ± 12, respectively, with moderate correlation (r = 0.50, p = 0.03). Compared with Med eyes, Trab Eyes had higher tBUT (6.5 ± 3.5 vs. 5.1 ± 2.7 s, p = 0.004), lower conjunctival hyperemia (0.8 ± 0.9 and 1.7 ± 1.1 respectively, p < 0.001) and lower corneal staining (0.3 ± 0.5 and 0.6 ± 0.5, respectively, p = 0.03). Correlation between corneal staining and conjunctival hyperemia was 0.55 in Trab Eyes (p = 0.01) and 0.44 in Med Eyes (p > 0.05). Patients with bilateral corneal staining had had threefold worse questionnaire scores (p < 0.05). The duration of treatment and the daily exposure to preservatives did not directly affect OS parameters in this cohort of patients. Conclusions: Patients receiving successful trabeculectomy showed better OS homeostasis (higher TBUT, lower grading of conjunctival hyperemia and corneal staining) than fellow medically treated eyes. Presence of corneal epithelial damage in both eyes is the factor more consistently affecting questionnaire scores.

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“… 6 Reducing IOP is presently the evidence-based, most accepted, and most practiced therapeutic approach of glaucoma patients. 7 Results of key landmark trials have shown that lowering intraocular pressure is the main stay of management. 8 …”

Section: Introductionmentioning

confidence: 99%

Cost Analysis and Rational Use of Anti-Glaucoma Therapy in a Tertiary Hospital in Ghana

Ofei-Palm¹,

Tagoe²,

Jatoe³

et al. 2021

CEOR

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Introduction Glaucoma is the leading cause of irreversible blindness worldwide. In Ghana, 19.4% of all blindness recorded is due to glaucoma. Reducing intraocular pressure medically (using eye drops) is the evidence-based therapeutic option. Objective To determine the rational use and undertake cost analysis of anti-glaucoma drugs among patients attending clinic at the Lions International Eye Centre (LIEC), Korle-Bu Teaching Hospital. Methods In this cross-sectional study, we reviewed all prescriptions presented to the pharmacy unit from 01/12/2015 to 31/03/2016. The dispensed drops were classified, and all anti-glaucoma drugs were identified. This was followed by cost analysis. Results A total of 588 prescriptions were captured, 27.3% (161/588) contained an anti-glaucoma medication. The mean number of anti-glaucoma medications was 1.71 of which 52.7% was prescribed to females. Prostaglandin analogs (PGA) were the most prescribed (37% (102/276)), followed by beta blockers (25.4% (70/276)), carbonic anhydrase group of medicines (16.3% (45/276)), combined beta blockers (11.2% (31/276)), alpha agonists (8.7% (24/276)) and miotics (1.4% (4/276)). The median (IQR) cost of anti-glaucoma therapy per prescription per month was GHC 65.00 (GHC38.5-GHC140) about [US$16.25 (US$ 9.6–US$35)]. Azopt (Brimonidine) was the most expensive with daily treatment cost of GHC 5.8 (about US$ 1.45), whilst the least expensive drug with a daily treatment cost of GHC 0.14 (about US$ 0.035) was timolol eye drops. Conclusion Prostaglandin analogs though expensive remain the most preferred treatment for managing glaucoma at the Korle-Bu Eye Centre in Ghana. This may adversely affect treatment among the poor since prostaglandins analogs are currently not covered by insurance.

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Reducing intraocular pressure: is surgery better than drugs?

Cited by 20 publications

References 94 publications

Treating patients presenting with advanced glaucoma--should we reconsider current practice?

Treating patients presenting with advanced glaucoma--should we reconsider current practice?

Inter-Eye Comparison of the Ocular Surface of Glaucoma Patients Receiving Surgical and Medical Treatments

Cost Analysis and Rational Use of Anti-Glaucoma Therapy in a Tertiary Hospital in Ghana

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