A study of initial therapy for glaucoma in Southern India: India glaucoma uutcomes and treatment (INGOT) study

Nathan G. Congdon*, R. Krishnadas, David S. Friedman, William Goggins, R. Ramakrishnan, M. A. Kader, Donna Gilbert, James Tielsch, Harry A. Quigley

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)

Abstract

Purpose: To compare initial glaucoma therapy with medications and trabeculectomy in southern India. Methods: Patients aged ≥30 years newly diagnosed with glaucoma were randomized to trabeculectomy with 5-fluorouracil or medical therapy. Subjects with best-corrected vision <6/18 due to cataract underwent phacoemulsification (phaco/intraocular lens, IOL). Intraocular pressure (IOP), vision and visual function were assessed at 12 months. Results: Patients assigned to medications and surgery received the expected therapy in 86% (172/199) and 64% (126/199) of cases, respectively. Forty patients (20%) assigned to surgery refused any treatment and 33 (17%) received medications. Among 199 patients randomized to medications, 52 (26.1%) underwent phaco/IOL, as did 89/199 (43.7%) of patients randomized to trabeculectomy. Baseline parameters of the two groups did not differ, nor did 1-year follow-up rates (medication 65%, trabeculectomy 58%, P = 0.15). Final IOP was lower with randomization to trabeculectomy (16.3±5.1 mmHg) than medication (18.8±6.7 mmHg, P < 0.0001). In regression models, randomization to trabeculectomy (P < 0.0001) was associated with lower IOP, and simultaneous trabeculectomy and cataract surgery was associated with higher IOP (P = 0.008) than trabeculectomy alone. Subjects receiving Phaco/IOL had significantly better final acuity (P < 0.0001) and visual function (P = 0.035), despite concurrent glaucoma treatment. Final visual acuity was worse in those receiving trabeculectomy in addition to cataract surgery, but this was of borderline significance (P 0.06). Conclusions: Trabeculectomy lowered IOP significantly more than medical treatment, but with slightly greater loss of visual acuity. Combined phaco/IOL and trabeculectomy improved visual acuity with substantial IOP lowering.

Original languageEnglish
Pages (from-to)149-158
Number of pages10
JournalOphthalmic Epidemiology
Volume19
Issue number3
DOIs
Publication statusPublished - Jun 2012
Externally publishedYes

Bibliographical note

Funding Information:
Financial Support: Funding for this study was provided by Pfizer, Inc., and donors to the Wilmer Glaucoma Research Fund; eyedrop medications were provided by Pfizer, Inc., Allergan, Inc., and Merck, Inc., and intraocular lenses were provided by Alcon Laboratories.

Keywords

  • Cataract
  • Glaucoma
  • India
  • Medication
  • Therapy
  • Trabeculectomy

ASJC Scopus subject areas

  • Epidemiology
  • Ophthalmology

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