Glaucoma Treatment

WEDNESDAY, July 2 (HealthDay News) -- Glaucoma doesn't necessarily have to end in blindness, two new studies suggest.

In one report, researchers say they found traditional surgery for glaucoma has better outcomes than using glaucoma drainage devices. The second report found that even patients with end-stage glaucoma can be successfully treated. Both studies were published in the July issue ofOphthalmology.

In the first report, researchers looked at the number of complications from traditional glaucoma surgery versus complications from inserting a device that drains fluid from the eye.

"We found a higher complication rate for glaucoma drainage devices than for traditional surgery," said lead researcher Frank Sloan, the Alexander McMahon Professor of Health Policy and Management at Duke University. "Of course, adverse outcomes for either procedure are rare."

In deciding between the two procedures, physicians will have to balance the risks versus the benefits, Sloan said. "It's good for ophthalmologists to have these outcome rates in mind when they counsel patients," he said.

In the study, Sloan and his colleagues collected data on 14,491 Medicare patients with glaucoma. These patients all underwent one of three surgeries. These included primary trabeculectomy (PT), trabeculectomy after scarring from previous surgery or trauma (TS), or the implanting of a glaucoma drainage device (GDD).

All these surgeries are designed to improve the drainage of fluid from the eye and reduce intraocular pressure. In trabeculectomy, a small portion of the tissue at the base of the cornea is removed to increase fluid flow, and in GDD a tiny shunt is implanted, which redirects fluid flow.

Sloan's group found that all of procedures had few adverse outcomes. However, GDD resulted in more patients progressing to low vision or blindness (2.6 percent), compared with patients who underwent PT (1 percent) or TS (1.3 percent).

Dr. Robert Cykiert, an ophthalmologist at New York University Medical Center and a clinical associate professor of ophthalmology at New York University School of Medicine in New York City, said that this study "says that one should try trabeculectomy procedure first, if you can."

In these patients, "experience and intuition says that additional trabeculectomy surgery usually won't work. That's why we go to a glaucoma drainage device," Cykiert said. "This study indicates that if there's any belief you can get away with doing a trabeculectomy procedure, you are better off doing that then putting in the drainage device."

These results will make people a little more conservative, Cykiert said. "Some glaucoma specialists jump ahead to the glaucoma drainage device sooner than they might or should," he noted.

In the second study, Dr. Jason W. Much, from the Department of Ophthalmology at the University of Virginia in Charlottesville, and his colleagues looked at the charts of 64 patients with end-stage glaucoma. All these patients were considered legally blind at the start of the study.