24-hour intraocular pressure control with maximum medical therapy compared with surgery in patients with advanced open-angle glaucoma.

Abstract

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. Prospective observational study. Thirty surgical patients and 30 medically treated patients with advanced glaucoma. 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. A 24-hour IOP control. 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 > or = 18 mmHg. The majority of peak IOPs (10 of 11) occurred outside of normal office hours. 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.