A study of initial therapy for glaucoma in southern India: India Glaucoma Outcomes and Treatment (INGOT) Study.

Abstract

PURPOSE:

To compare initial glaucoma therapy with medications and trabeculectomy in southern India.

METHODS:

Patients aged ≥ 30 years newly diagnosed with glaucoma were randomized to trabeculectomy with 5-fluorouracil or medical therapy. Subjects with best-corrected vision <6/18 due to cataract underwent phacoemulsification (phaco/intraocular lens, IOL). Intraocular pressure (IOP), vision and visual function were assessed at 12 months.

RESULTS:

Patients assigned to medications and surgery received the expected therapy in 86% (172/199) and 64% (126/199) of cases, respectively. Forty patients (20%) assigned to surgery refused any treatment and 33 (17%) received medications. Among 199 patients randomized to medications, 52 (26.1%) underwent phaco/IOL, as did 89/199 (43.7%) of patients randomized to trabeculectomy. Baseline parameters of the two groups did not differ, nor did 1-year follow-up rates (medication 65%, trabeculectomy 58%, P = 0.15). Final IOP was lower with randomization to trabeculectomy (16.3 ± 5.1 mmHg) than medication (18.8 ± 6.7 mmHg, P < 0.0001). In regression models, randomization to trabeculectomy (P < 0.0001) was associated with lower IOP, and simultaneous trabeculectomy and cataract surgery was associated with higher IOP (P = 0.008) than trabeculectomy alone. Subjects receiving Phaco/IOL had significantly better final acuity (P < 0.0001) and visual function (P = 0.035), despite concurrent glaucoma treatment. Final visual acuity was worse in those receiving trabeculectomy in addition to cataract surgery, but this was of borderline significance (P = 0.06).

CONCLUSIONS:

Trabeculectomy lowered IOP significantly more than medical treatment, but with slightly greater loss of visual acuity. Combined phaco/IOL and trabeculectomy improved visual acuity with substantial IOP lowering.

• Authors: Nathan G Congdon, R Krishnadas, David S Friedman, William Goggins, R Ramakrishnan, M A Kader, Donna Gilbert, James Tielsch, Harry A Quigley
• Journal: Ophthalmic epidemiology (Ophthalmic Epidemiol) Vol. 19 Issue 3 Pg. 149-58 (Jun 2012) ISSN: 1744-5086 [Electronic] England
• PMID: 22568428 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antihypertensive Agents
• Antimetabolites, Antineoplastic
• Drug Combinations
• Prostaglandins F, Synthetic
• Quinoxalines
• Sulfonamides
• Thiophenes
• dorzolamide-timolol combination
• Brimonidine Tartrate
• Latanoprost
• Timolol
• Fluorouracil

Topics

• Aged
• Antihypertensive Agents (therapeutic use)
• Antimetabolites, Antineoplastic (administration & dosage)
• Brimonidine Tartrate
• Drug Combinations
• Female
• Fluorouracil (administration & dosage)
• Glaucoma (drug therapy, physiopathology, surgery)
• Humans
• India
• Intraocular Pressure (physiology)
• Latanoprost
• Lens Implantation, Intraocular
• Male
• Middle Aged
• Phacoemulsification
• Prospective Studies
• Prostaglandins F, Synthetic (therapeutic use)
• Quinoxalines (therapeutic use)
• Sulfonamides (therapeutic use)
• Surveys and Questionnaires
• Thiophenes (therapeutic use)
• Timolol (therapeutic use)
• Tonometry, Ocular
• Trabeculectomy
• Visual Acuity (physiology)