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Eugenio Maul de la Puente, Jaime Tapia, Alan Kastner; Patients presenting with severe glaucomatous visual field defect benefit from both surgical and medical treatment. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4780.
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To compare the outcome of surgical and medical therapy in patients with severe glaucomatous visual field damage at presentation. A severe visual field defect at presentation has been considered an indication for primary surgery (1).
A retrospective chart review of patients presenting to our clinic over a 5-year period (2007-2011) with open angle glaucoma (OAG), severe visual field damage (Mean Deviation < -20dB ) in at least one eye and >= 1 year of follow-up was conducted. Outcomes compared across groups included proportion of patients with a 3dB loss in the mean deviation (MD) and proportion patients with a 2-line loss of visual acuity.
Of 70 patients presenting with severe visual field loss in at least one eye, 49 (54 eyes) had >= 1 year of follow-up. Thirteen (24%) and 41 (76%) eyes received initial surgical and medical treatment respectively. Mean age at presentation (SD) was 67.5 (11.8) years and median follow-up 2.9 years (Interquartile Range, IQR=2.0-4.9). The surgical and medical treatment groups were comparable with respect to baseline age (66.8 vs 67.7 years), MD (-26.0 vs -25.5 dB) and logMar best corrected visual acuity (0.29 vs 0.25). The surgical group had longer follow-up (5.1 (2.7) vs 3.1 (1.66) years, p-value= 0.02) and a higher number of visual field tests (7.1 (5.0) vs 4.3 (2.8) tests, pvalue= 0.07) The proportion of eyes experiencing a 3-dB MD loss was 14% and 0% in the sugical and medical treatment group respectively (p-value=0.3). The proportion of eyes experiencing a 2-line loss of visual acuity was 29% and 27% in the surgical and medical treatment groups respectively. (P=1)
The present study showed comparable visual outcomes in eyes presenting with severe visual field damage treated with surgery or medically. It may provide insight to the risk faced by patients with advanced glaucoma enroling in clinical trials exploring treatment alternatives (3). 1.King AJ et al.: Treating patients with advanced glaucoma - should we reconsider current practice. Brit J Ophthamol 2011; 95: 1185-92 2.Mills RP et al.: Categorizing the end stage glaucoma from prediagnosis to end stage disease. Amer. J Ophthalmol 2006; 141:24-30 3.Leighton P et al.: The willingness of patients presenting with advanced glaucoma to participate in a trial comparing primary medical vs primary surgical treatment. Eye 2012; 26:300-6
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