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Abstract #13885 Published in IGR 8-2
24-hour intraocular pressure control with maximum medical therapy compared with surgery in patients with advanced open-angle glaucoma
Konstas AG; Topouzis F; Leliopoulou O; Pappas T; Georgiadis N; Jenkins JN; Stewart WCOphthalmology 2006; 113: 765e1
See also comment(s) by Erik Greve •
PURPOSE: The purpose of this study was to evaluate 24-hour intraocular pressure (IOP) control in patients with moderate to severe open-angle glaucoma treated by trabeculectomy and mitomycin C versus maximum tolerated medical therapy. DESIGN: Prospective observational study. PARTICIPANTS: Thirty surgical patients and 30 medically treated patients with advanced glaucoma. METHODS: Patients successfully treated with initial trabeculectomy or patients considered successfully treated on maximum tolerated medical therapy (2-4 medicines) were enrolled. We performed IOP measurements at 6 a.m., 10 a.m., 2 p.m., 6 p.m., 10 p.m., and 2 a.m. Patients were matched by IOP ± 1 mmHg at 10 a.m. MAIN OUTCOME MEASURES: A 24-hour IOP control. RESULTS: The surgical patients had a mean diurnal IOP of 12.1 ± 2.2 versus 13.5 ± 2.0 mmHg for the matched medically treated patients (P = 0.0001). The average maximum IOP for the surgical group was 13.4 ± 2.3 and 16.3 ± 3.2 mmHg for the medical group (P < 0.0001). The 24-hour range of IOP for the surgical group was 2.3 ± 0.8 and 4.8 ± 2.3 mmHg for the medical group (P < 0.0001). Except at 10 am (P = 0.5), the surgical group had a statistically lower IOP at each measured time point. Eleven (37%) patients in the medically treated group, and none in the surgically treated group, had peak IOPs ≥ 18 mmHg. The majority of peak IOPs (10 of 11) occurred outside of normal office hours. CONCLUSIONS: This study suggests that a well-functioning trabeculectomy provides a statistically lower mean, peak, and range of IOP for the 24-hour day than maximum tolerated medical therapy in advanced glaucoma patients.
Dr. W.C. Stewart, Glaucoma Unit, University Department of Ophthalmology, Australasian Hellenic Educational Progressive Association Hospital, Thessaloniki, Greece
Classification:
11.1 General management, indication (Part of: 11 Medical treatment)
12.1 General management, indication (Part of: 12 Surgical treatment)
