24-hour intraocular pressure control with maximum medical therapy compared with surgery in patients with advanced open-angle glaucoma.
| Title | 24-hour intraocular pressure control with maximum medical therapy compared with surgery in patients with advanced open-angle glaucoma. |
| Publication Type | Journal Article |
| Year of Publication | 2006 |
| Authors | Konstas, A. G. P., Topouzis F., Leliopoulou O., Pappas T., Georgiadis N., Jenkins J. N., & Stewart W. C. |
| Journal | Ophthalmology |
| Volume | 113 |
| Issue | 5 |
| Pagination | 761-5.e1 |
| Date Published | 2006 May |
| ISSN | 1549-4713 |
| Keywords | Aged, Antihypertensive Agents, Circadian Rhythm, Drug Therapy, Combination, Female, Glaucoma, Open-Angle, Humans, Intraocular Pressure, Male, Prospective Studies, Tonometry, Ocular, Trabeculectomy |
| Abstract | 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 am, 10 am, 2 pm, 6 pm, 10 pm, and 2 am. Patients were matched by IOP +/- 1 mmHg at 10 am.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 mm Hg 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 > or = 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. |
| DOI | 10.1016/j.ophtha.2006.01.029 |
| Alternate Journal | Ophthalmology |
| PubMed ID | 16650670 |
