Medical versus surgical interventions for open angle glaucoma.

摘要: Background Open angle glaucoma (OAG) is a common cause of blindness. Objectives To assess the effects medication compared with initial surgery in adults OAG. Search methods We searched CENTRAL (which contains Cochrane Eyes and Vision Group Trials Register) (The Library 2012, Issue 7), Ovid MEDLINE, MEDLINE In-Process Other Non-Indexed Citations, Daily, OLDMEDLINE (January 1946 to August 2012), EMBASE 1980 Latin American Caribbean Literature on Health Sciences (LILACS) 1982 Biosciences Information Service (BIOSIS) 1969 Cumulative Index Nursing Allied (CINAHL) 1937 OpenGrey (System for Grey Europe) (www.opengrey.eu/), Zetoc, metaRegister Controlled (mRCT) (www.controlled-trials.com) WHO International Clinical Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions electronic searches trials. last databases 1 2012. The National Research Register (NRR) was 2007 after which database archived. also checked reference lists articles contacted researchers field. Selection criteria We included randomised controlled trials (RCTs) comparing medications OAG. Data collection analysis Two authors independently assessed trial quality extracted data. study missing information. Main results Four involving 888 participants previously untreated OAG were included. Surgery Scheie's procedure one trabeculectomy three In trials, primary usually pilocarpine, it beta-blocker. The most recent average mild OAG. At five years, risk progressive visual field loss, based unit change composite score, significantly different according (odds ratio (OR) 0.74, 95% confidence interval (CI) 0.54 1.01). an analysis mean difference (MD) as single index between treatment group MD -0.20 decibel (dB) (95% CI -1.31 0.91). For subgroup more severe (MD -10 dB), findings from exploratory suggest that associated marginally less loss at years than medication, (mean 0.74 dB -0.00 1.48). Initial lower intraocular pressure (IOP) 2.20 mmHg 1.63 2.77) but eye symptoms (P = 0.0053). Beyond acuity differ (OR 1.48, 0.58 3.81). From OAG, there some evidence 3 8 IOP lowering surgery. longer-term (two trials) failure greater 3.90, 1.60 9.53; hazard (HR) 7.27, 2.23 25.71). Medications have evolved since these undertaken. In developing cataract higher 2.69, 1.64 4.42). Evidence suggests that, beyond needing policy 0.63, 0.15 2.62). Methodological weaknesses identified all trials. Authors' conclusions Primary lowers discomfort. One restriction whether trabeculectomy. There two small (pilocarpine, now rarely used first line medication) progression no need treatment. The clinical cost-effectiveness contemporary (prostaglandin analogues, alpha2-agonists topical carbonic anhydrase inhibitors) known. Further RCTs current medical treatments are required, particularly people black ethnic groups. Outcomes should include those reported by patients. Economic evaluations required inform policy.