Comparative Evaluation of the Efficacy and Safety of Primary Trabeculectomy and Drug Therapy in Patients with Advanced Open-angle Glaucoma

The aim of the study was to evaluate the effectiveness and safety of primary trabeculectomy in comparison with drug therapy in patients with advanced open-angle glaucoma in order to determine the optimal approach to reducing intraocular pressure and maintaining the quality of life of patients. Materials and methods. A randomized controlled trial was conducted involving 143 adult patients aged 60–85 years who were recently diagnosed with progressive open-angle glaucoma. The patients were divided into two groups: 75 people received trabeculectomy, 68 people received medical treatment. The main outcome is the quality of life after 12 months, assessed using the VFQ-25 questionnaire. Intraocular pressure, visual acuity, and average deviation of the visual fields were considered as secondary outcomes. Results. At the end of 24 months, there were no significant differences in quality of life (VFQ-25) between the groups ( p = 0.38). Trabeculectomy provided a more significant reduction in intraocular pressure at all stages of the study, reducing the need for topical medications. Complications were successfully resolved in both groups, and the frequency of serious side effects was comparable. Conclusion. Primary trabeculectomy is an effective strategy for reducing intraocular pressure in patients with glaucoma, while maintaining quality of life at a level comparable to drug treatment. Despite the lower need for medications after the procedure, the risk of complications requires attention, emphasizing the need for an individual approach to treatment. Future research should focus on improving treatment methods to improve long-term therapy outcomes.