Findings from a 5-year study published in Ophthalmology demonstrated promising results for surgical intervention.
Give me some background first.
Loss of vision due to glaucoma can often be prevented if treated early. And in the United Kingdom (UK), medical management of glaucoma is the current standard of treatment .
Historically speaking, ophthalmologists typically refer glaucoma patients to undergo trabeculectomy only if medical management of glaucoma is not successful.
This is primarily to the limited evidence available about the benefits of trabeculectomy.
Now, talk about the study.
This study compared the effectiveness and safety of trabeculectomy to medical management for patients presenting with open-angle glaucoma (OAG) using a multi-center randomized controlled trial (RCT) design.
Who was included in the study?
A total of 453 patients from 27 hospitals were randomly assigned to each case, with 227 undergoing trabeculectomy and 226 undergoing medical management.
The clinical, demographic, and quality of life (QoL) variables of both cohorts matched evenly at baseline.
Findings?
At the 5-year follow-up, patients with surgery had a mean deviation (MD) of -14.30 (7.14) dB while patients who underwent medical management had an MD of -16.74 (6.78) dB.
Significance: Patients receiving trabeculectomy demonstrated significantly less disease progression.
Tell me more.
Trabeculectomy reduced intraocular pressure (IOP) to 12.07 (5.18) mmHg while medical management reduced IOP to 14.8 (4.1) mmHg at the 5-year mark.
As lowering IOP levels is the most effective method of preventing further visual field loss in glaucoma patients, these results show that trabeculectomy can be more effective at reducing IOP and preserving vision.
Anything else?
Neither intervention had a significant difference in QoL at 5 years.
Limitations?
Per the investigators, some of the data collection was incomplete, partly due to the COVID-19 pandemic.
Further, the majority of participants were Caucasian, which may have limited the generalizability of these findings to non-Caucasian groups.
Expert opinion?
Based on this data, the study authors stated that, “trabeculectomy should be offered as a primary intervention in patients presenting with advanced glaucoma.”
Take home.
The proven effectiveness of trabeculectomy in managing glaucoma and lowering IOP levels demonstrated its potential to be presented as a top choice to advanced glaucoma patients.