Medical therapy versus trabeculectomy in patients with open-angle glaucoma

ABSTRACT Purpose: To compare therapeutic outcomes between trabeculectomy and medical therapy in patients with open-angle glaucoma. Methods: In the present retrospective comparative study, the medical charts of 284 patients (eyes) newly diagnosed with open-angle glaucoma who had received conventional medications (n=188) or undergone fornix-based trabeculectomy (n=96) at a teaching eye hospital were reviewed. Results: At a mean follow-up of 6.6 years, post-treatment changes in intraocular pressure (IOP), visual field (VF), best spectacle-corrected visual acuity (BSCVA), and number of required drugs were significantly more favorable in the surgical group (P<0.001 for all comparisons). However, the frequency of clinically desirable IOP (≤21 mmHg) at the endpoint was comparable between the surgical and medical groups (87.2% vs. 82.3%; P=0.26). The rate of conversion to surgical therapy was 34% in the medical group. A greater baseline requirement for anti-glaucoma drugs (two or more) was the only independent predictor of treatment failure in the present study. Conclusions: Although more severe cases naturally receive trabeculectomy, the surgical approach had greater efficacy than conventional medical therapy in patients with open-angle glaucoma. An initial requirement for two or more anti-glaucoma drugs may predict failure of medical therapy.

摘要 目的：比较小梁切除术（trabeculectomy）与药物治疗在开角型青光眼（open-angle glaucoma）患者中的治疗效果。方法：本回顾性对照研究纳入某教学眼科医院新诊断为开角型青光眼的284例（眼）患者，其中188例接受常规药物治疗，96例接受穹窿部小梁切除术（fornix-based trabeculectomy），对其病历资料进行回顾分析。结果：平均随访6.6年时，手术组患者的眼压（intraocular pressure, IOP）、视野（visual field, VF）、最佳矫正视力（best spectacle-corrected visual acuity, BSCVA）及所需抗青光眼药物数量的术后改善情况均显著优于药物组（所有比较均P<0.001）。然而，两组研究终点时临床理想眼压（≤21 mmHg）的达标率无显著差异（手术组87.2% vs. 药物组82.3%；P=0.26）。药物组患者转为手术治疗的比例为34%。基线时需使用2种及以上抗青光眼药物是本研究中治疗失败的唯一独立预测因素。结论：尽管病情更严重的患者通常会选择小梁切除术，但在开角型青光眼患者中，手术治疗的疗效优于常规药物治疗。基线时需使用2种及以上抗青光眼药物可预测药物治疗失败。