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G.L. Skuta, L.F. Cashwell, P.R. Lichter, D.C. Musch, K.E. Guire, CIGTS Study Group; What is the IOP-reducing Effect of Argon Laser Trabeculoplasy After Failure of Initial Treatment with Medications Versus Surgery? . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1216.
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Purpose: Argon laser trabeculoplasty (ALT) is a commonly used method to reduce intraocular pressure (IOP) in glaucoma treatment. While numerous studies have documented its effect to reduce IOP, the Collaborative Initial Glaucoma Treatment Study (CIGTS) protocol required ALT as the next step of treatment after initial medication or initial surgery had failed, providing an opportunity to compare its relative efficacy. Methods: A review of the current CIGTS database showed that 155 ALTs have been completed — 89 in the medication arm, and 66 in the surgery arm. Most ALTs (86%) were performed due to inadequate IOP control. Results: Using the IOP measured at the last study follow-up visit prior to conducting the ALT (average time before ALT=51 days), and the IOP measured at the first study follow-up visit after ALT (average time after ALT=128 days), there was a 4.9 mmHg reduction (SD, 4.7 mmHg) in IOP overall (from 22.5 mmHg to 17.7 mmHg; P<0.0001). Those initially treated with medication showed an IOP reduction effect from ALT of 5.4 mmHg (SD, 4.8 mmHg), which marginally exceeded that seen in initial surgery patients, 4.0 mmHg (SD, 4.4 mmHg), P=0.07. The amount of IOP reduction did not vary significantly by age or race, although the amount of reduction in blacks (4.3 mmHg) was 1.2 mmHg less (P=0.16) than in whites (5.5 mmHg). This resulted in a significantly lower IOP after ALT in whites than in blacks (16.4 vs. 18.7 mmHg, respectively; P=0.003). Conclusions: These findings provide some insight to the differential effect of ALT after initial medication or initial surgery has failed.
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