Selective laser trabeculoplasty versus 0·5% timolol eye drops for the treatment of glaucoma in Tanzania: a randomised controlled trial.
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Author
Philippin, HeikoMatayan, Einoti
Knoll, Karin M
Macha, Edith
Mbishi, Sia
Makupa, Andrew
Matsinhe, Cristóvão
da Gama, Vasco
Monjane, Mario
Ncheda, Awum Joyce
Mulobuana, Francisco Alcides
Muna, Elisante
Fopoussi, Nelly
Gazzard, Gus
Marques, Ana Patricia
Shah, Peter
Macleod, David
Makupa, William U
Burton, Matthew J
Publication date
2021-10-13Subject
Ophthalmology
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Background: Glaucoma is a major cause of sight loss worldwide, with the highest regional prevalence and incidence reported in Africa. The most common low-cost treatment used to control glaucoma is long-term timolol eye drops. However, low adherence is a major challenge. We aimed to investigate whether selective laser trabeculoplasty (SLT) was superior to timolol eye drops for controlling intraocular pressure (IOP) in patients with open-angle glaucoma. Methods: We did a two-arm, parallel-group, single-masked randomised controlled trial at the Eye Department of Kilimanjaro Christian Medical Centre, Moshi, Tanzania. Eligible participants (aged ≥18 years) had open-angle glaucoma and an IOP above 21 mm Hg, and did not have asthma or a history of glaucoma surgery or laser. Participants were randomly assigned (1:1) to receive 0·5% timolol eye drops to administer twice daily or to receive SLT. The primary outcome was the proportion of eyes from both groups with treatment success, defined as an IOP below or equal to target pressure according to glaucoma severity, at 12 months following randomisation. Re-explanation of eye drop application or a repeat SLT was permitted once. The primary analysis was by modified intention-to-treat, excluding participants lost to follow-up, using logistic regression; generalised estimating equations were used to adjust for the correlation between eyes. This trial was registered with the Pan African Clinical Trials Registry, number PACTR201508001235339. Findings: 840 patients were screened for eligibility, of whom 201 (24%) participants (382 eligible eyes) were enrolled between Aug 31, 2015, and May 12, 2017. 100 (50%) participants (191 eyes) were randomly assigned to the timolol group and 101 (50%; 191 eyes) to the SLT group. After 1 year, 339 (89%) of 382 eyes were analysed. Treatment was successful in 55 (31%) of 176 eyes in the timolol group (16 [29%] of 55 eyes required repeat administration counselling) and in 99 (61%) of 163 eyes in the SLT group (33 [33%] of 99 eyes required repeat SLT; odds ratio 3·37 [95% CI 1·96-5·80]; p<0·0001). Adverse events (mostly unrelated to ocular events) occurred in ten (10%) participants in the timolol group and in eight (8%) participants in the SLT group (p=0·61). Interpretation: SLT was superior to timolol eye drops for managing patients with open-angle high-pressure glaucoma for 1 year in Tanzania. SLT has the potential to transform the management of glaucoma in sub-Saharan Africa, even where the prevalence of advanced glaucoma is high. Funding: Christian Blind Mission, Seeing is Believing Innovation Fund, and the Wellcome Trust.Citation
Philippin H, Matayan E, Knoll KM, Macha E, Mbishi S, Makupa A, Matsinhe C, da Gama V, Monjane M, Ncheda AJ, Mulobuana FA, Muna E, Fopoussi N, Gazzard G, Marques AP, Shah P, Macleod D, Makupa WU, Burton MJ. Selective laser trabeculoplasty versus 0·5% timolol eye drops for the treatment of glaucoma in Tanzania: a randomised controlled trial. Lancet Glob Health. 2021 Nov;9(11):e1589-e1599. doi: 10.1016/S2214-109X(21)00348-X. Epub 2021 Oct 13Type
ArticleOther
Additional Links
http://www.thelancet.com/journals/langlo/issue/currentPMID
34655547Journal
The Lancet Global HealthPublisher
Elsevierae974a485f413a2113503eed53cd6c53
10.1016/S2214-109X(21)00348-X