Prognostic Factors for Failure of Initial Treatment of POAG

Abstract

Abstract: : Purpose: While the primary outcome of the Collaborative Initial Glaucoma Treatment Study (CIGTS) is progression in visual field (VF) loss, the CIGTS protocol is designed to institute new treatment steps if either the IOP is poorly controlled, or the VF demonstrates progressive loss. In both initial medicine and surgery arms, failure of the initial treatment leads to argon laser trabeculoplasty (ALT). Since the number of initial treatment failures have now been documented (n=153 with available data for a survival analysis), we can begin to evaluate risk factors for failure of initial treatment. Most failures (86%) were due to inadequate IOP control. Methods: Cox proportional hazards survival analyses were conducted to identify risk factors for first intervention failure in the overall patient group and in the initial medication and initial surgery arms of the CIGTS. Results: In all patients, surgical treatment was protective against failure, whereas more severe baseline visual field loss, diabetes, and a family history of glaucoma increased the risk of failure. Within the two treatment groups, these same risk factors are seen except for baseline severity of loss, which was significant only within medically treated patients. Conclusions: Initial surgery resulted in a decreased risk of intervention failure. Within treatment groups, shared risk factors included diabetes and a family history of glaucoma. Initial severity of VF loss was only a risk factor for intervention failure within patients treated with initial medication. Cox Proportional Hazards Survival Analyses for Time to First Intervention Failure  

Keywords: clinical (human) or epidemiologic studies: ris • clinical (human) or epidemiologic studies: tre