Main finding: Both initial medical or initial surgical therapy resulted in similar visual field outcome at 5 years
Purpose: To assess the effect of two different treatment approaches in newly diagnosed open-angle glaucoma – initial therapy with topical medications or trabeculectomy
Study type: Randomized controlled trial
Condition: Open Angle glaucoma
Participants: 25-75yo, newly diagnosed open-angle glaucoma, BCVA 20/40 or better OU, no prior ocular surgery, limited or no prior treatment
n=607
Intervention:
Group 1: Initial topical hypotensive (sequence of medications starting with beta-blocker) → ALT → trabeculectomy (+/- 5-fluorouracil)
Group 2: Initial trabeculectomy (+/- 5-fluorouracil) → ALT → topical medications
At 8-year follow up, substantial worsening (≥3 dB) of mean deviation from baseline was lower in the initial surgery than initial medical group (21.3% vs 25.5%).
In patients with advanced VF loss at baseline, initial surgery led to less visual field progression than initial medical treatment.
Patients with diabetes had more VF loss over time if treated initially with surgery
November 1, 2001
Clinical trial
Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery.
Main finding: Both initial medical or initial surgical therapy resulted in similar visual field outcome at 5 years
Purpose: To assess the effect of two different treatment approaches in newly diagnosed open-angle glaucoma – initial therapy with topical medications or trabeculectomy
Study type: Randomized controlled trial
Condition: Open Angle glaucoma
Participants: 25-75yo, newly diagnosed open-angle glaucoma, BCVA 20/40 or better OU, no prior ocular surgery, limited or no prior treatment
n=607
Intervention:
Group 1: Initial topical hypotensive (sequence of medications starting with beta-blocker) → ALT → trabeculectomy (+/- 5-fluorouracil)
Group 2: Initial trabeculectomy (+/- 5-fluorouracil) → ALT → topical medications
There was no significant difference in visual field loss between both groups.
Patients who underwent initial surgery had greater risk of substantial visual acuity loss compared to initial medical treatment, although average VA was similar by 4 years.
The rate of cataract removal was greater in the initial surgical group.
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