Primary trabeculectomy for advanced glaucoma : pragmatic multicentre randomised controlled trial (TAGS)
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Objective : To determine whether primary trabeculectomy or primary medical treatment produces better outcomes in term of quality of life, clinical effectiveness, and safety in patients presenting with advanced glaucoma. Design : Pragmatic multicentre randomised controlled trial. Setting : 27 secondary care glaucoma departments in the UK. Participants : 453 adults presenting with newly diagnosed advanced open angle glaucoma in at least one eye (Hodapp classification) between 3 June 2014 and 31 May 2017. Interventions : Mitomycin C augmented trabeculectomy (n=227) and escalating medical management with intraocular pressure reducing drops (n=226). Main outcome measures : Primary outcome: vision specific quality of life measured with Visual Function Questionnaire-25 (VFQ-25) at 24 months. Secondary outcomes: general health status, glaucoma related quality of life, clinical effectiveness (intraocular pressure, visual field, visual acuity), and safety. Results : At 24 months, the mean VFQ-25 scores in the trabeculectomy and medical arms were 85.4 (SD 13.8) and 84.5 (16.3), respectively (mean difference 1.06, 95% confidence interval −1.32 to 3.43; P=0.38). Mean intraocular pressure was 12.4 (SD 4.7) mm Hg for trabeculectomy and 15.1 (4.8) mm Hg for medical management (mean difference −2.8 (−3.8 to −1.7) mm Hg; P<0.001). Adverse events occurred in 88 (39%) patients in the trabeculectomy arm and 100 (44%) in the medical management arm (relative risk 0.88, 95% confidence interval 0.66 to 1.17; P=0.37). Serious side effects were rare. Conclusion : Primary trabeculectomy had similar quality of life and safety outcomes and achieved a lower intraocular pressure compared with primary medication.
TAGS Study Group , King , A J , Hudson , J , Fernie , G , Kernohan , A , Azuara-Blanco , A , Burr , J , Homer , T , Shabaninejad , H , Sparrow , J M , Garway-Heath , D , Barton , K , Norrie , J , McDonald , A , Vale , L , MacLennan , G & Kousha , O 2021 , ' Primary trabeculectomy for advanced glaucoma : pragmatic multicentre randomised controlled trial (TAGS) ' , BMJ , vol. 373 , n1014 . https://doi.org/10.1136/bmj.n1014
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DescriptionFunding: The project was funded by the National Institute of Health Research (NIHR) Health Technology Assessment (HTA) Programme (project number 12/35/38). The Health Services Research Unit is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.
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