ABSTRACT
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.
RESUMO Objetivo: Comparar o resultado terapêutico de trabeculectomia versus terapia médica em pacientes com glaucoma de ângulo aberto. Método: Neste estudo comparativo retrospectivo, prontuários médicos de 284 pacientes (olhos), de um hospital de ensino oftalmológico, com diagnóstico recente de glaucoma de ângulo aberto que receberam medicamentos convencionais (n=188) ou foram submetidos a trabeculectomia de base fórnice (n=96) foram revisados. Resultados: Com seguimento médio de 6,6 anos, as mudanças pós-tratamento da pressão intraocular (PIO), campo visual (VF), melhor acuidade visual corrigida por óculos (BSCVA), e o número de medicações necessárias foram significativamente mais favorável ao grupo cirúrgica (p<0,001 para todas as comparações). No entanto, os grupos foram comparáveis para a frequência de PIO clinicamente desejável (≤21 mmHg) na visita final (87,2% vs. 82,3%, respectivamente; p=0,26). A taxa de conversão para o tratamento cirúrgico foi de 34% no grupo médico e a necessidade inicial de mais drogas antiglaucomatosas (2 ou mais) foi o único preditor independente desta conversão. Conclusões: Embora os casos mais graves de glaucoma são naturalmente designados o grupo de trabeculectomia, esta abordagem cirúrgica se mostrou mais eficaz do que a terapia médica convencional em pacientes com glaucoma de ângulo aberto. Uma necessidade inicial de 2 ou mais medicações antiglaucomatosas pode prever a falha em terapia médica.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Trabeculectomy/methods , Glaucoma, Open-Angle/surgery , Glaucoma, Open-Angle/drug therapy , Time Factors , Visual Acuity/physiology , Visual Fields/physiology , Retrospective Studies , ROC Curve , Follow-Up Studies , Treatment Outcome , Statistics, Nonparametric , Intraocular PressureABSTRACT
To report an unusual presentation of pellucid marginal degeneration [PMD]. A 57-year-old man with history of corneal ectasia experienced acute hydrops and spontaneous corneal perforation in his right eye. Examination revealed PMD in both eyes. After initial treatment with cyanoacrylate adhesive and a bandage contact lens, therapeutic penetrating keratoplasty was undertaken in the right eye. Due to severity of the condition, the fellow eye was also scheduled for penetrating keratoplasty. Spontaneous corneal hydrops and perforation may occur in patients with corneal ectasia due to PMD