LONG-TERM FUNCTIONAL OUTCOME AFTER EARLY SURGERY COMPARED WITH LASER AND MEDICINE IN OPEN-ANGLE GLAUCOMA

Purpose: This randomly allocated prospective clinical study was design ed to assess the relative efficacy of laser trabeculoplasty, medical t herapy, and trabeculectomy used as the primary treatment in open-angle glaucoma, with particular regard to the level of intraocular pressure control and the amount of visual field decay. No patient had received any antiglaucoma treatment before entry into the trial. Methods: One hundred sixty-eight patients were entered into the trial and randomly allocated into one of the three treatment groups-laser, medicine, or s urgery. Followup was for a minimum of 5 years. The patients were monit ored in the standard way, including intraocular pressure estimations a nd visual field tests (initially using the Friedmann analyzer and late r including Humphrey automated perimetry). Results: Despite similar in itial composition of the three treatment groups, primary surgery resul ted in the lowest mean intraocular pressures. The perimeter Friedmann visual fields were shown to have deteriorated in patients in the medic ine-treated group and to a lesser extent in patients in the laser-trea ted group, but not in patients in the surgery-treated group. Multivari ate linear regression analysis showed that the difference in field cha nges between laser and surgical treatments could be explained entirely by the difference between the intraocular pressure values at 6 months between the two groups. The same was not true for the medicine-treate d group. Conclusion: Primary trabeculectomy appears to have the desire d effect in preserving visual function in patients with high-tension g laucoma. This may be related to the pressure-lowering effect. A simila r fall in intraocular pressure with medicine and/or laser treatment mi ght be expected to have the same effect.