A comparison of medical and surgical intervention for primary open-angle glaucoma.

Abstract

Aim: To compare surgery versus new-generation glaucoma medication for the control of intraocular pressure (IOP) in primary open-angle glaucoma (POAG). In uncontrolled glaucoma, the glaucomatous process may lead to blindness. PICO question: In patients with Primary Open-angle Glaucoma, how does surgical treatment compare with new generation anti-glaucoma drugs in effecting IOP fluctuations and control? Method: A literature review guided by the PICO question was accomplished to find the latest evidence-based knowledge for the best medical and/or surgical interventions for POAG. The data sources included the CINAHL, Cochrane, and PubMed databases, along with books and relevant journals. Intraocular pressure control was identified as an indicator of the outcome of interest across selected studies. The pulsatile ocular blood flow (POBF) was also considered as primary outcome by one study. The identification of studies that best answered the PICO question was achieved following the PRISMA guidelines. The appraisal was guided by the CASP tool for RCTs. Results: 277 articles were retrieved, from which five studies were identified as eligible to answer the PICO question. These consisted of one RCT, three quasi-experimental, and one retrospective studies. The total number of participants was 494 of which 251 were treated surgically and 243 medically. Trabeculectomy was shown to reduce IOP the most, while the prostaglandin analogue eye drops emerged as second best treatment option. Furthermore, the prostaglandin analogues were shown to increase POBF markedly more than any other treatment approach. Conclusion: In cases of POAG with associated high IOP and/or poor compliance, trabeculectomy was shown to be the treatment of choice, whereas the prostaglandin analogues were preferred in cases of compromised ocular perfusion or where trabeculectomy was contraindicated. Local practices are not in line with this evidence and there seems to be the need for a revision of local treatment protocols and the setting of national guidelines.