SURGICAL VS MEDICAL-MANAGEMENT OF CHRONIC OPEN-ANGLE GLAUCOMA

PURPOSE: We studied patients with chronic open angle glaucoma who had similar intraocular pressures to determine whether surgical or medical cal therapy is more effective in preventing progressive, long-term, g laucomatous damage. METHODS: Included in this study were patients with chronic open angle glaucoma who were followed for 3 years or longer a nd were treated, through either medical or surgical therapy, by adjust ing intraocular pressure to 18 mm Hg or less as a therapeutic end poin t. We studied 31 matched pairs of patients in which one member was tre ated by surgery and one member had medical treatment. In every pair, w e matched each patient individually by age, race, and intraocular pres sure. RESULTS: For the matched pairs of patients in this study, the me an intraocular pressure following initiation of treatment was 13.5 and 13.1 mm Hg for the surgically and medically treated groups, respectiv ely (P =.475), This study found no difference between groups in the in cidence of glaucomatous progression following surgical (n = 3) or medi cal (n = 3) therapy (P >.99, McNemar's test) for an average follow up of 40.0 +/- 10.0 and 43.4 +/- 8.4 months in the medical and surgical g roups, respectively. The glaucoma of three patients progressed on the basis of reduced visual acuity, two by visual field, and one by disk h emorrhage. Although the types of complications from therapy differed b etween groups, no vision loss or life-threatening events occurred dire ctly from these treatments. CONCLUSIONS: When intraocular pressure is used as a therapeutic end point, both filtration surgery and medical t herapy appear to be equally effective in maintaining long-term visual function and a stable optic disk in chronic open-angle glaucoma.