JOURNAL OF PHARMACY

Pharmacotheraphy Of An Open Angel Glaukoma : Study

Cases
Hendra R.
Papeo, S. PululawaIrmaI.Salwa DewaAyupuspitaDewi
P Dizky., M.S.Farm., Apt. Marhaba, Zulkarnain. Badjeber, B.
Samsul. Igirisa, M. Karsum.

v2 Received 16 April 2021

Received in revised from 27 April 2021
Received in revised from 3 Mei 2021

Abstract
The glaucomas are a group of ocular disorders that lead to an optic neuropathy characterized by changes
in the optic nerve head (optic disk) that is associated with loss of visual sensitivity and field. Two major
types of glaucoma have been identified : open angle and closed angle. There are several risk factors that
can accompany the development of a glaucoma, namely family history, age, gender, race, genetics, exercise
and drugs. The method used in this practicum is SOAP which consists of subjective, object, assessment and
planning. The purpose of this study was to analyze case studies related to glaucoma in order to find the
right solution in the therapeutic treatment of patients. Based on the results of the research conducted, the
recommended therapies for glaucoma sufferers are pharmacological and non-pharmacological therapies.
In this case, the pharmacological therapy given to glaucoma patients is Timolol and sodium chromoglycate.
In non-pharmacological therapies that can be suggested, such as taking vitamin A, doing a healthy lifestyle
and surgical therapy such as selective laser trabeculoplasty.

Keywords
Glaucoma, Pharmacological Therapy, Non Pharmacological Therapy
REVISED Amendments from Version 1 Preliminary
Change in this journal are the addition of The glaucomas are a group of ocular disorders
therapeutic pharmacology from patients and
consultation, information and education of that lead to an optic neuropathy characterized
the drug in patients by changes in the optic nerve head (optic disk)
that is associated with loss of visual sensitivity
and field. Increased intraocular pressure (IOP)

1|Page
is thought to play an important role in the
pathogenesis of glaucoma, but it is not a
diagnostic criterion for glaucoma. Consistently
high IOP without signs or symptoms of
glaucoma is called ocular hypertension (OHT).
Two major types of glaucoma have been
identified: open angle and closed angle. Open-
angle glaucoma (OAG) accounts for the great
majority of cases in North America, while
primary angle closure glaucoma (PACG) is
more prevalent in Asia. Either type can be a
primary inherited disorder, congenital, or
secondary to disease, trauma, or drugs and can
lead to serious complications. Both primary
and secondary glaucomas may be caused by a
combination of open-angle and closed-angle
mechanisms. Patients with consistently high
IOP, or patients with clinical findings
suspicious of early glaucomatous changes are
called. [2,3,4,11,12,16]
(Picture 1. Normal Eyes and Eyes With Glaucoma)
[12]
Primary open-angle glaucoma is a bilateral,
often asymmetric, genetically determined
disorder constituting 60% to 70% of all
glaucomas and 90% to 95% of primary
glaucomas in the United States (see Clinical
Presentation of Glaucoma above). An
increased IOP is not required for diagnosis of
POAG. Symptoms do not present until
substantial visual field constriction occurs.
Central visual acuity typically is maintained
even in the late stages of the disease. Even
though POAG is a bilateral disease, it may
have greater IOP and progression and severity
in one eye. As such, each eye is treated
individually [2,4,11,12,16]
Increased IOP during such prodromal episodes
is not great enough or long enough to produce
the other symptoms of a full-blown attack.
Such prodromal attacks last 1 to 2 hours, at
which time pupillary block is broken by further
mydriasis or miosis, or when miosis or
mydriasis occurs in patients with plateau iris.
The rate at which IOP increases may be a
determinant of when full-blown symptoms
occur. Visual fields demonstrate generalized
constriction or typical glaucomatous defects as
seen in POAG. In approximately 25% of
patients, severe attacks may occur and if
prolonged, total loss of vision may occur if the
IOP is high enough. Tonometry reveals IOPs
as high as 40 to 90 mm Hg (5.3 to 12.0 kPa).
Patients who have developed adhesions
between the iris and meshwork (anterior
2|Page
synechiae) may have chronic IOP elevation
with intermittent spikes of high IOP when
angle closure occurs.[12,16]
The aim of this study was to describe the
clinical characteristics and management of
patients diagnosed with secondary glaucoma
and the importance of initial therapy in
reducing IOP.
The specific cause of glaucomatous optic
neuropathy is presently unknown. Previously,
increased IOP was considered to be the sole
cause of the damage; however, it is now
recognized that IOP is only one of many
factors associated with the development and
progression of glaucoma. Increased
susceptibility of the optic nerve to ischemia (a
reduced or dysregulated blood flow),
excitotoxicity, autoimmune reactions, and
other abnormal physiologic processes are
likely additional contributory factors. The final
outcome of these processes is believed to be
apoptosis of the retinal ganglion cells, which
results in axonal degeneration and finally
permanent loss of vision. POAG may represent
a number of distinct diseases or conditions that
simply manifest the same symptoms.
Susceptibility to visual loss at a given IOP
varies considerably; some patients do not
demonstrate damage at high IOPs, whereas
other patients have progressive visual field loss
despite an IOP in the normal range (normal
tension glaucoma).[2,3,11,12,13]
Methods
The method used in this practice is SOAP
which consists of subjective, object,
assessment and planning. KIE
(communication, information and education)
contains a form of counseling that will be
given to patients. The patient data used were
obtained by cross sectional from the patient's
medical record file.
Study case
A 12 year old child with a history of vernal
keratoconjuctivitis (VKC) was referred from
private practice an ophthalmologist to the
hospital complaining of blurred eyes and
intraocular pressure (IOP) In the right eye even
though he had received 4 combinations of
glaucoma drugs.
During the examination at the hospital, visual
acuity in the right eye was only 1 meter away
by looking at the finger while the sharp left eye
is 2 meters away. There are signs of visible
efferent pupil damage. The measurement of
intraocular pressure in the right eye was 31.8
mmHg and in the left eye 27.2 mmHg.
The results of the optical disc photo look pale
with a cup-to-disc ratio (CDR) of 0.9 in the
3|Page
right eye and 0.8 in the left eye. Visual field
examination (VF) shows tunnel vision visual
field defects in the right and left eyes. Medical
history: routine dexamethasone eye drops since
4 years ago.
Even though he has been given optimum anti-
glaucoma treatment, this child's vision has
deteriorated due to uncontrolled IOP and the
child's vision condition has become severe low
vision. In the end, IOP was controlled with one
type of anti-glaucoma drug without medical
intervention, controlled VKC with sodium
chromoglycate eye drops and improves.
However, there is no improvement in visual
acuity and the visual field remains narrowed.
Discussion
a. Subjective
This patient had blurred eyes and increased
intraocular pressure (IOP) in the right eye
which had not changed after being given 4
combination glaucoma drugs. The increase
in intraocular pressure is due to a
disturbance in the eye fluid flow system,
where when the patient suffers from this
condition, he can experience symptoms in
the form of visual disturbances, eye pain to
headaches.
b. Objective
On examination the sharpness between the
left eye and the right eye was different and
there were several signs of efferent pupil
damage. Likewise, an intraocular pressure
(IOP) examination was carried out. The
results obtained from the left eye and right
eye exceeded the normal IOP value, namely
10-21 mmHg. The difference in IOP values
in the right and left eyes was caused by the
sleeping position of the patient and also due
to choroid vessel congestion and increased
episclera venous pressure. The nerves
between the right eye and the left eye are
connected to each other and the mechanism
is that when the episclera vein pressure
increases, the eye tissue will experience
choroidal swelling. the part of the eye that
is filled with blood vessels will expand and
cause changes in the dynamics of the eye
fluid. Well, in eyes with trabecular flow
disturbances it will cause an increase in
IOP.
c. Assessment
According to the patient data obtained, this
patient used Dexamethasone eye drops for
4 years routinely. Dexamethasone is used
here to treat inflammation and bacterial
infections that occur in the eye. However,
we stopped using the Dexamethasone eye
drops because they are a class of
costicosteroids which have a high risk of
increasing intraocular pressure so that they
are the cause of this secondary galucoma.
4|Page
 To treat vernal keratoconjuctivitis (VKC) Glaucoma is a group of eye disorders that
patients use sodium chromoglycate eye cause optic neuropathy characterized by
drops. We continue to use it because it is changes in the head of the optic nerve (optic
used as a recovery. disk) associated with loss of sensitivity and
field of vision. Increased intraocular pressure
d. Planning (IOP) is thought to play an important role in
In this case, we recommend that the pathogenesis of glaucoma, but it is not a
pharmacological therapy be given to diagnostic criterion for glaucoma. A
patients using a beta adrenergic antagonist persistently high IOP without signs or
(β blocker) drug, namely Timolol, to treat symptoms of glaucoma is called ocular
the decrease in intraocular pressure. The hypertension (OHT). Two main types of
reason for administering the drug Timolol glaucoma have been identified: open angle and
to patients is because it is the main closed angle. Open-angle glaucoma (OAG)
therapeutic choice for most types of occurs in the majority of cases in North
glaucoma. Thymolol can also act directly America, whereas primary closed-angle
on the ciliary epithelium to block active glaucoma (PACG) is more common in Asia.
transport or ultrafiltration. While the non- Either type can be a primary, congenital, or
pharmacological therapy provided is secondary congenital disorder due to disease,
consuming vitamin A which is used as trauma, or drugs and can cause serious
prevention, doing a healthy lifestyle such as complications. Both primary and secondary
dynamic exercise, namely jogging because glaucoma can be caused by a combination of
jogging can increase colloid pressure, open-angle and closed-angle mechanisms.
which is closely related to a decrease in Patients with a consistently high IOP, or
IOP and is the most important determinant patients with suspicious clinical findings of
factor in the offer. IOP, doing laser therapy early glaucoma changes are termed.
or surgery, this is done when eye drops [2,3,4,11,12,16]
have been given but when visual acuity and Primary open-angle glaucoma often occurs in
IOP checks are carried out for 1 week, 1 black (negroid) and white (Caucasian) people.
month, 3 months, 6 months and 1 year but Meanwhile, there were many cases of closed-
there is no change of about 20%, it is angle primary glaucoma in Asian and Inuit
advisable to do therapy laser or surgery. races. Glaucoma Prevalence in Indonesia The

5|Page
results from the Jakarta Urban Eye Health
Study 2008 for closed-angle primary glaucoma
were 1.89%, for primary open-angle glaucoma
it was 0.48%, and secondary glaucoma was
0.16%.[5]
One of the symptoms of glaucoma is an
increase in intraocular pressure that exceeds
the normal range (IOP). The normal value of
intraocular pressure (IOP) is 10-20 mmHg,
drugs that have a high risk of increasing
intraocular pressure (IOP), namely the
corticostiroid group and someone who has a
history of diabetes mellitus, the chance of
glaucoma is greater than those who do not have
a drug. diabetes mellitus due to diabetes plays
a role in optic nerve damage via mechanical
and vascular pathways. Where the mechanical
pathway can result in an increase in intra-
ocular pressure (IOP) while through the
vascular pathway it can result in a decrease in
ocular perfusion pressure. Therefore, if the
hormone insulin decreases, the blood pressure
increases, causing pressure to the eye which
can cause major damage to the optic nerves.
[6,7,10,14]
If the intraocular pressure is high only in the
right eye it is caused by the sleeping position
of the patient and also due to choroid vessel
blockage and increased pressure on the
episclera vein. The nerves between the right
eye and the left eye are interconnected and the
mechanism is that when the episclera vein
pressure increases, the eye tissue will
experience choroidal swelling. the part of the
eye that fills with blood vessels will expand
and cause changes in the dynamics of the eye
fluid. Well, in eyes with trabecular flow
disturbances it will cause an increase in IOP.
[6,7,10]
There are several ways to overcome the
increase in intraocular pressure (IOP), the first,
by jogging because it can increase colloid
pressure, which is closely related to a decrease
in IOP and is the most important determinant
of IOP reduction. And the second
Consumption of vitamin A to prevent the
severity of eye disease. Vitamin A is used as
prevention, because some of the content of
vitamin A, namely carotene (carrots), beta-
carotene, lutein, zeaxanthine, is found in
carrots as an anti-oxidant which plays a role in
reducing free radical damage to the eyes.[7,10]
a. Subjective and Objective
A 12 year old child with a history of vernal
keratoconjunctivitis (VKC) was referred from
the private practice of an ophthalmologist to
the hospital with complaints of blurred eyes
and intraocular pressure in the right eye and
measurement of intraocular pressure in the
right eye 31,8 mmHg and in the left eye 27, 2
mmHg.
6|Page
The results of optical dics look pale with a
Cup-to-dics ratio (CDR) of 0.9 in the right eye
and 0.8 in the left eye. Visual field examination
(VF) shows tunnel Vision Visual field defects
in the right and left eyes.
It is known that the patient has a history of
using dexamethasone eye drops for 4 years.
Dexamethasone is used to reduce inflammation
that occurs in the patient's eye. Where
dexamethasone has advantages and
disadvantages, the advantages given are that it
belongs to a class of steroid drugs that act to
reduce inflammation or help block the immune
system's response to inflammation. While the
disadvantages, Dexamethasone can lower the
immune system, prolonged use can cause eye
problems such as cataracts or glaucoma, can
also cause damage to the optic nerve or eye
infections caused by fungi or viruses.
In the history of IOP treatment, the patient was
controlled with 1 type of anti-glaucoma drug
without any medical intervention. Controlled
VKC with sodium chromoglycate eye drops.
The patient took the drug dexametasone for 4
years and was diagnosed with secondary
glaucoma.
b. Treatment Goals
The goal of therapy for glaucoma patients is to
maintain visual function by reducing the IOP
to a level where no further optic nerve damage
occurs. Because of the poor association
between IOP and optic nerve damage, no
specific IOP target exists. Medicines used to
treat glaucoma may work to stop visual field
loss through mechanisms separate from or in
addition to IOP reduction, such as
improvements in retinal or choroidal blood
flow.

c. Assessment and Planning

Tabel 1. Assessment

Deksametasone
Indication according to To reduce mild to moderate poin, espicially poin due to
literature inflammation such as arthritis and gout.
Case Indication Headache
Dosage according to Mild to moderate pain orally 200-400 mg
literature
Case dosage Prn (prorenata)
Right alert Incorrect use in patients

7|Page
 ESO alert Ibuprofen has side effects of gastrointestinal discomfort,
nausea, diarrhea, sometimes bleeding and ulceration.
Kes Coresponding

Sodium chromoglycate
Indication according to Allergic conjunctivitis
literature
Case Indication Treating vernal keratoconcjungtivitis (VKC)
Dosage according to 100 mg for Children 2-10 years
literature
Case dosage Use the eye drops 4 times a day
Right alert Use is correct in the patient
ESO alert Temporary burning and stinging
Kes Coresponding
1. Pharmacological Therapy Brimonidine and topical CAIs are also well tol-
erated and effective agents, but often
Medications most commonly used to treat
considered second-line agents (to
glaucoma are the prostaglandin analogs,
prostaglandins and β-blockers). [5]
brimonidine (αlfa 2-agonist), βeta-blockers,
non-selective, the topical CAIs, and the fixed Therapy optimally is started asa single agent,
combination products of timolol with and may be started in one eye (except for
dorzolamide, timolol with brimonidine, patients with very high IOP or advanced visual
brimonidine with brinzolamide, or timolol with field loss) to evaluate drug efficacy and
prostaglandins. The prostaglandin analogs are tolerance, although response may differ
often recommended as first-line therapy. The between contralateral eyes. Monitoring of
use of a once-daily dose, better IOP reduction, therapy should be individualized. Initial check
better 24-hour IOP control, good tolerance, and for IOP response to therapy is typically done 4
availability of generic drugs at lower cost. The to 6 weeks after the medication is started. Once
topical βeta-blockers have a long history of IOPs reach acceptable levels, the IOP is
successful use, providing a combination of monitored every 3 to 4 months or longer if
clinical efficacy and general tolerability. there is prolonged control (over 6-12 months)
8|Page
without progression. More frequent monitoring
is necessary if the IOP target is not achieved,
disease progression is noted, and after any
change in drug therapy. [5]
Patients responding to but intolerant of initial
therapy may be switched to another drug. For
patients failing to respond to an initial drug,
a switch to an alternative agent should be
considered. If only a partial response occurs,
addition of another topical drug to be used in
combination is a possibility. A number of
drugs or drug combinations may need to be
tried before an effective and well-tolerated
regimen is identified. Prostaglandin agonists,
βeta-blockers, brimonidine, CAIs,
pilocarpine may be used in various
combinations. Adding a second drug generally
results in a less-than-additive reduction in IOP.
Using more than one drop per dose does not
improve response but rather increases the
likelihood of adverse effects and the cost of
therapy. When using more than one
medication, separation of drop instillation of
each agent by at least 5 minutes is suggested to
provide optimal ocular absorption.
Combination products reduce the number of
daily doses, possibly improving adherence and
preventing washout effect seen when a second
medication is administered too soon after the
initial medication. Because of the frequency of
adverse effects, dipivefrin, carbachol, topical
cholinesterase inhibitors, and oral CAIs are
and
considered last-line agents to be used for
patients who fail less-toxic combination topical
therapy. [5]

Table 2. Planning Pharmacological Therapy

Timolol Maleat
Indication Reduce intraocular pressure especially in open angle glaucoma
Dosage Timolol 0.5% solution , twice a day with a workin g time of more
than 7 hours
Drug Side effect Local adverse effects with β-blockers, stinging on application, are
common. Other local effects include dry eye, corneal
anesthesia,blepharitis, blurred vision, and, rarely, conjunctivit is,
uveitis, and keratitis.

Sodium Chromoglycate

Indication Allergic conjunctivitis

Dosage CHILDREN 2-14 years 100 mg

9|Page
 Drug side effect Sometimes nausea, skin redness, joint pain
Timolol maleate is a beta adrenergic
antagonist (βeta-blocker) drug which is the
main therapeutic choice for most types of
glaucoma. It is a non-selective βeta-blocker
which has the effect of lowering IOP by
decreasing the production of aquos by blocking
beta-2 receptors in the ciliary process. Timolol
can act directly on the ciliary epithelium to
block active transport or ultrafiltration. The
dose of use of timolol solution 0.5% twice a
day with a working time of more than 7 hours.
βeta blockers will reduce IOP by about 26% to
27% from baseline. [10,13,14]
2. Non-pharmacological therapy
Management of non-pharmacological therapy
for children aged 12 years is the consumption
of vitamin A to prevent the severity of eye
disease. Vitamin A is used as prevention,
because some of the content of vitamin A,
namely carotene (carrots), βeta-carotene,
lutein, zeaxanthine, is found in carrots as an
anti-oxidant which plays a role in reducing free
radical damage to the eyes. The mechanism of
vitamin A that we get is generally only in the
eye, the form of vitamin A that is obtained
from the blood is oxidized to become retinal.
Then the retinal binds to the opsin protein and
forms the visual pigment red purple or
rhodopsin. Raw carrots contain 509
micrograms of RAE vitamin A and also
provide 5050 mcg of βeta-carotene and 2,120
mcg of alpha carotene and 2 provitamin A
antioxidants, which the body can convert into
more vitamin A as needed. To meet the needs
of daily vitamin A intake, adults need to
consume about five servings of fruits and
vegetables per day. Meanwhile, in children,
vitamin A intake can be adjusted depending on
their age. Vitamin A is also available in
supplement form which has a dose of 23,000
IU / week given before, during and after
pregnancy and for adults and children over 1
year of age the dose is 200,000 IU / day for 2
days given again in a single dose after 2 weeks.
[7]
The things that must be considered when
taking vitamin A are adjusting to a diet where
there are certain types of vitamins that will not
work well on an empty stomach, vitamins do
not have to be consumed every day, you cannot
take vitamins by using drinks that contain
caffeine. and do not take vitamins in doses that
are too high because it can interfere with the
body's metabolism and if there is a buildup it
will be toxic in the body. [7,10]
10 | P a g e
Patients must also adopt a healthy lifestyle.
A healthy lifestyle recommended for glaucoma
sufferers is more on dynamic sports where one
example of this dynamic exercise is jogging.
By doing jogging can increase colloid pressure
which is closely related to the decrease in IOP
and is the most important determining factor in
the decrease in IOP. [10]
If pharmacological therapy fails, the patient
will undergo surgical therapy where the
surgery we recommend, namely selective laser
trabeculoplasty (TLS) is used as the first line
of treatment with exclusion criteria being under
18 years of age. To find out when laser therapy
or surgery was performed, a sharp visual
examination and IOP was performed for 1
week, 1 month, 3 months, 6 months and 1 year
but there was no change in about 20%.
[1,6,8,9]
Communication, Information and
Education
Patients are advised to avoid sleeping on their
stomach, turn on the light while sleeping, rest
their eyes when reading and observe activities
from a close distance with a broad view, carry
out regular eye examinations, use drugs that
can lower intraocular pressure and increase
patient adherence to the use of drops eye.
Conclusion
Based on the case studies that have been
conducted, the 12 year old patient is advised to
undergo Pharmacological and Non
Pharmacological therapy. Pharmacological
therapy is given in the form of administration
of the drug Timolol as the first line in the
prevention of secondary glaucoma and
continues to use sodium chromatoglycate to
treat vernal keratoconjuctivitis (VKC) for the
better. In non-pharmacological therapies, we
recommend that patients take vitamin A, lead a
healthy lifestyle and surgical therapy such as
selective laser trabeculoplasty if the patient's
condition does not change after being given
pharmacological therapy.
Acknowledgements
Thank you to the lecturer in charge of the
Pharmacotherapy II practicum, Mrs. Dr. Widy
Susanti Abdulkadir, M.Sc., Apt., Mrs. Endah
Nurrohwinta Djuwarno, M.Sc., Apt. and Ms.
Dizky Ramadani Putri Papeo, M.S.Farm., Apt.
We also thank the practicum assistants,
especially Zulkarnain Marhaba who has been
willing to be a reviewer for our journal. Thank
you also to colleagues from the A-S1 class of
Pharmacy 2018 who have provided
suggestions and input as well as support in
making this journal. Finally, thank you
profusely to all those who have assisted the
author in completing this journal.
References
11 | P a g e
1. Abdelrahman AM, Eltanamly RM. 8. Hirn C, Zweifel SA, Toteberg-Harm M,
Selective laser trabecuplasty in Egyptian Funk J. Effectiveness of selective laser
patients with primary open angle trabeculoplasty in patients with insufficient
glaucoma. Middle East Afr J Ophthamol. control of intraocular pressure despite
2012;19(3):299-303. 16. maximum tolerated medical theraphy.
Ophthalmolog. 2012 100(7):683-90.15
2. American Academy of Ophthalmology
Glaucoma Panel. Preferred Practice 9. Klamann MK, Maier AK, Gonnermann J,
Pattern Guidelines. Primary open angle Ruokonen PC. Adverse effects and and
glaucoma. San Francisco, CA. American short-term results after selective laser
trabeculoplasty (SLT). J Glaucoma. 2012;
Academy of Ophthalmology. 2010.
Aug 14 9 (Epub). 14
Available at: www.aao.org/ppp 1
10. Kristine A. Erickson. Basic Aspects of
3. American Academy of Ophthalmology
Parasympathetic Pharmacology. Dalam:
Glaucoma Panel. Preferred Practice
Robert R, Shields MB, Krupin T, Editors.
Pattern Guidelines. Primary angle
The Glaucomas. 2th ed. USA: Mosby Year
closure. San Francisco, CA. American
Book; 1996. hlm. 1385-1398. 7
Academy of Ophthalmology. 2010.
Available at: www.aao. org/ppp 2
11. Kwon YH, Fingert JH, Kuehn MH,
Alward WLM. Primary open-angle
4. American Academy of Ophthalmology
glaucoma. N Engl J Med 2009;360:1113-
Glaucoma Panel. Preferred Practice
1124. 8
Pattern Guidelines. Primary open angle
glaucoma suspect. San Francisco, CA.
12. Quigley HA. Glaucoma. Lancet
American Academy of Ophthalmology.
2011;377:1367-1377. 9
2010. Available at: www.aao.org/ppp 3
13. Sachdeva D, Bhandari A. Glaucoma and
5. Dipiro J.T., Wells B.G., Schwinghammer
beta-blockers. American J Pharm Tech
T. L. And Dipiro C.V. 2017.
Res. 2011; 1(4):144-53 10
Pharmacotherapy Handbook, Tenth
14. Sethi HS, Dhawan M, Saxena R. Medical
Edition. Mc graw-hill Education
Management of Glaucoma. Dalam: Garg
Companies: Inggris 4
A, Editor. Mastering the Techniques of
Glaucoma Diagnosis & Management.
6. Gedde SJ, Schiffman JC, Feuer WJ,
New Delhi: Jaype Brothers Medical
Herndon LW, Brandt JD, Budenz DL,
Publisher; 2005. hlm: 137-157. 11
Tube versus Trabeculectomy Study Group
Treatment Outcomes in the Tube Versus
15. Svern P, Scott F, Finch T, May C. Which
Trabeculectomy (TVT) study after five
quality of life score is best for glaukoma
years of follow-up. Am J Ophthalmol.
patients and why? BMC Ophthalmol 2008;
2012;153:789–803. 5
8:2 12
7. Gupta V, Ov M, Rao A, et al. Longterm
16. Weinreb RN, Aung T, Madeiros FA. The
structural and functional outcomes of
pathophysiology and treatment of
therapy in juvenileonset primary open
glaucoma. JAMA 2014;311:1901-1911.
angle glaucoma: a five-year follow-up.
13
Ophthalmologica 2012;228:19–25. 6

12 | P a g e