The purpose of this report is to present separately for black and white patients with advanced glaucoma 7-year results of two alternative surgical intervention sequences.
Design
A randomized controlled trial.
Participants
A total of 332 black patients (451 eyes), 249 white patients (325 eyes), and 10 patients of other races (13 eyes) participated. Potential follow-up ranged from 4 to 7 years.
Intervention
Eyes were randomly assigned to either an argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy (ATT) sequence or a trabeculectomy-ALT-trabeculectomy (TAT) sequence. The second and third interventions were offered after failure of the first and second interventions, respectively.
Main outcome measures
Average percent of eyes with decrease of visual field (APDVF), average percent of eyes with decrease of visual acuity (APDVA), and average percent of eyes with decrease of vision (APDV) are the outcome measures. Decrease of visual field (DVF) is an increase from baseline of at least 4 points on a glaucoma visual field defect scale ranging from 0 to 20, decrease of visual acuity (DVA) is a decrease from baseline of at least 15 letters (3 lines), and decrease of vision (DV) is the occurrence of either DVF or DVA. The averages are of percent decreases observed at 6-month intervals from the first 6-month visit to the end of the specified observation period.
Results
In both black and white patients throughout 7-year follow-up, the mean decrease in intraocular pressure was greater in eyes assigned to TAT, and the cumulative probability of failure of the first intervention was greater in eyes assigned to ATT. In black patients, APDVF, APDVA, and APDV are less for the ATT sequence than for the TAT sequence throughout the 7 years. In white patients, APDVF also favors the ATT sequence but only for the first year, after which it favors the TAT sequence through the seventh year; APDVA also favors the ATT sequence, but the ATT-TAT difference progressively diminishes over 7 years; and APDV favors ATT over TAT initially, but after 4 years, the advantage switches to and remains with TAT.
Conclusions
These data support use of the ATT sequence for all black patients. For white patients without life-threatening health problems, the data support use of the TAT sequence.
Supported by grants from the National Eye Institute, National Institutes of Health, U.S. Department of Health and Human Services (grants 2 U10 EY06824 through 2 U10 EYO6827, 2 U10 EY06830 through 2 U10 EY06835, 2 U10 EY07057, and 7 U10EY09640).
The writing team for this report is Douglas E. Gaasterland, MD, Fred Ederer, MA, FACE, E. Kenneth Sullivan, PhD, Paul C. Van Veldhuisen, MS, M. Angela Vela, MD, and Howard Weiss, MD. Members of the Advanced Glaucoma Intervention Study are listed in the Appendix at the end of this article.
