Primary argon laser trabeculoplasty vs pilocarpine. IV. Long-term effects on optic nerve head.

In a prospective, randomized study on primary argon laser trabeculoplasty vs piloparpine in 82 newly detected open-angle glaucomas the progress of optic nerve head damage is presented. In 70 patients reliable stereo photographs could be analysed. In the laser treated group a progression of glaucoma damage after 24 months was seen in 6/37 eyes (16%) and in the pilocarpine-treated group 16/33 (49%) (p = 0.0048). There was a statistically significant favourable outcome if intraocular pressure was regulated in terms of peak and range of pressure, but not average pressure. This was even more pronounced in capsular glaucoma, but not significant for simple glaucoma. Pilocarpine increased the risk for further damage to the optic nerve head 6.4 times compared to laser trabeculoplasty. Thus, laser is recommended as the primary therapy in high tension glaucoma, especially in capsular glaucoma.