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Randomized Controlled Trial
. 2009 Apr;147(4):717-724.e1.
doi: 10.1016/j.ajo.2008.10.007. Epub 2009 Jan 18.

Five-year follow-up optic disc findings of the Collaborative Initial Glaucoma Treatment Study

Richard K Parrish 2nd  1 , William J Feuer, Joyce C Schiffman, Paul R Lichter, David C Musch; CIGTS Optic Disc Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Five-year follow-up optic disc findings of the Collaborative Initial Glaucoma Treatment Study

Richard K Parrish 2nd et al. Am J Ophthalmol. 2009 Apr.

Abstract

Purpose: To determine the effect of intraocular pressure (IOP) lowering on the optic disc in patients of the Collaborative Initial Glaucoma Treatment Study (CIGTS) after 5 years.

Design: Randomized clinical trial.

Methods: The baseline and 5-year stereoscopic optic disc photographs of 348 eyes (patients) randomized to medical or surgical treatment of open-angle glaucoma (OAG) were assessed by 2 independent readers for change in a masked side-by-side comparison, and confirmed by an independent committee.

Results: Three hundred and three (87.1%) eyes showed no change, 22 (6.3%) showed enlargement of the cup along any meridian (progression), and 23 (6.6%) showed a reduction in the cup along any meridian (reversal of cupping). Incidence of optic disc progression was higher (P = .007) in the medicine group, 18/185 (10%) than in the surgical group 4/163 (3%); and the incidence of reversal of cupping was higher (P < .001) in the surgical group, 21/163 (13%), than the medicine group, 2/185 (1%), (P < .001). Visual field (VF) worsening (mean deviation) was significantly associated with progression of optic disc cupping (P < .001). Reversal of cupping was also associated with lower postoperative IOP (P < .001). Reversal of cupping was not associated with improvement of either visual acuity or central VFs.

Conclusions: Surgery prevents or delays glaucomatous progression as measured by optic disc criteria in patients with early OAG. Reversal of cupping occurs more frequently in the surgical group than in the medical treatment group. Reversal is associated with lower IOP, but is not associated with improved visual function.

Trial registration: ClinicalTrials.gov NCT00000149.

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Figures

Figure 1
Figure 1
Reversal of optic disc cupping in a patient in the Collaborative Initial Glaucoma Treatment Study (CIGTS) five-year optic disc study with IOP reduction from 22 mm Hg to 7 mm Hg 61 months after trabeculectomy Left: Before surgery Right: 61 months after trabeculectomy
Figure 1
Figure 1
Reversal of optic disc cupping in a patient in the Collaborative Initial Glaucoma Treatment Study (CIGTS) five-year optic disc study with IOP reduction from 22 mm Hg to 7 mm Hg 61 months after trabeculectomy Left: Before surgery Right: 61 months after trabeculectomy
See this image and copyright information in PMC

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References

    1. Musch DC, Lichter PR, Guire KE, Standardi CL CIGTS Study Group. The Collaborative Initial Glaucoma Treatment Study: Study design, methods, and baseline characteristics of enrolled patients. Ophthalmology. 1999;106:653–662. - PubMed
    1. Lichter PR, Musch DC, Gillespie BW, et al. Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery. Ophthalmology. 2001;11:1943–1953. - PubMed
    1. Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study. A Randomized Trial Determines That Topical Ocular Hypotensive Medication Delays or Prevents the Onset of Primary Open-Angle Glaucoma. Arch Ophthalmol. 2002;120:701–713. - PubMed
    1. Chandler PA, Grant WM. Lectures on glaucoma. Philadelphia: Lea & Feibiger; 1965. p. 327.
    1. Shaffer RN, Hetherington J. The glaucomatous disc in infants. A suggested hypothesis for disc cupping. Trans Am Acad Ophthalmol Otolaryngol. 1968;73:929–935. - PubMed

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