A review of surgical alternatives to medical therapy for glaucoma.

Results of four uncontrolled studies, with short-term follow-up, of argon laser trabeculoplasty (ALT) as initial treatment for various open-angle glaucomas indicate short-term success varies from 65 to 90 percent. The success rates are less impressive when the definition of success, usually intraocular pressure 22 mmHg or less, and the short follow-up, usually limited to months, are considered. The ongoing, multicenter, random-assignment, controlled Glaucoma Laser Trial in the United States will provide additional information about short- and long-term follow-up of primary ALT that will clarify the accuracy of the results of these preliminary trials.Results of another study suggest that initial filtering surgery is as effective at controlling intraocular pressure and preserving visual function as medical treatment for newly diagnosed glaucoma. All these clinical studies are difficult to interpret and suffer from the lack of data analysis using the life-table method. The comparatively low rate of long-term success of ALT for open-angle glaucoma performed after failure of medical management, particularly in blacks, cautions that ALT may not be a good substitute for medications or filtering surgery in newly diagnosed glaucoma.