Primary trabeculectomy associated with similar outcomes as medical management for advanced glaucoma

1. At 24 months, visual quality of life for patients with advanced open angle glaucoma was similar if treated initially with trabeculectomy or with medical management.

Evidence Level Rating: 1 (Excellent)

Glaucoma is one of the leading causes of blindness in the U.S., and the incidence is increasing due to an aging population. Open angle glaucoma in particular is difficult to manage, with some practitioners opting for trabeculectomy as a primary intervention, though there are a paucity of robust data to support this, especially among patients presenting with advanced disease. This multicenter, randomized controlled trial compared primary medical management with primary trabeculectomy for patients presenting with untreated open angle glaucoma. The primary outcome was quality of life as measured by the Visual Function Questionnaire-25 (VFQ-25) at 24 months. 227 patients were randomized to undergo trabeculectomy (mean [SD] age = 67 [12.2] years, 69% male) and 226 to receive medical management (mean [SD] age = 68 [12.4] years, 65% male). It was found that, at 24 months, there was no significant difference in mean VFQ-25 scores between the trabeculectomy and medical management cohorts (85.4±13.8 vs. 84.5±16.3, mean difference 1.06, 95% CI -1.32 to 3.34, p = 0.38). The mean intraocular pressure, however, was significantly lower in the trabeculectomy cohort. Adverse events were similar between the two cohorts. In all, no difference between trabeculectomy and medical management for the treatment of advanced open angle glaucoma was seen. Surgery was safe and effective at reducing intraocular pressure. Such findings will help guide decision making for patients presenting with advanced disease.

Click to read the study in BMJ

Image: PD

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