A 60-year-old patient with POAG on maximum tolerated medical therapy shows continued progression. On gonioscopy, the angle is open to grade 4 in all quadrants. The Collaborative Initial Glaucoma Treatment Study (CIGTS) found that comparing initial medical vs. surgical treatment, which outcome was observed?
- A Surgery achieved significantly better visual field preservation at 5 years
- B Medications were superior in preventing optic nerve damage
- C Both treatments resulted in similar visual field outcomes but surgery led to more cataract formation ✓
- D Surgery was superior in reducing IOP but medications had better quality of life scores
Explanation
The CIGTS (Collaborative Initial Glaucoma Treatment Study) found that both initial medical therapy and initial surgical therapy (trabeculectomy) achieved similar visual field outcomes at 5-year follow-up in newly diagnosed POAG patients. However, the surgical arm had significantly higher rates of cataract formation (approximately 55% vs. 20%). The surgery group achieved lower IOP initially, but the functional outcomes were equivalent, supporting that either approach is valid for initial management. The choice may be individualized based on cataract risk and patient preference.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.