24-Hour Intraocular Pressure Control with Maximum Medical Therapy Compared with Surgery in Patients with Advanced Open-Angle Glaucoma
Received 2 May 2005; accepted 12 January 2006.
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 ≥ 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.
1Glaucoma Unit, University Department of Ophthalmology, Australasian Hellenic Educational Progressive Association Hospital, Thessaloniki, Greece
2University Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
3Pharmaceutical Research Network, LLC, Charleston, South Carolina
4Carolina Eye Institute at the University of South Carolina School of Medicine, Columbia, South Carolina
Correspondence and reprint requests to William C. Stewart, MD, Pharmaceutical Research Network, LLC, 1 Southpark Circle, Suite 110, Charleston, SC 29407
Manuscript no. 2005-388.
This study was not supported by any outside funding agency or company.
ABSTRACT