Trabecular microbypass as replacement therapy in pharmacologically controlled open-angle glaucoma patients / Implante de by-pass trabecular como alternativa aos colírios em portadores de glaucoma de ângulo aberto controlados com tratamento clínico

ABSTRACT Purpose: To assess the outcomes of the trabecular bypass as replacement therapy for medications in pharmacologically controlled vs. pharmacologically uncontrolled open-angle glaucoma patients. Methods: This was a retrospective study of eyes treated with first- (iStent) or second-generation (iStent inject) trabecular bypass. Group 1 consisted of eyes with pharmacologically controlled intraocular pressure <18 mmHg and Group 2 consisted of eyes with pharmacologically controlled intraocular pressure ≥18 mmHg. The main outcomes measured were qualified (with or without medications) and unqualified or complete (without medications) success rates at different target intraocular pressures, mean reduction (%) in medication use, and proportion of medication-free eyes. Results: The mean age was 70.4 years in Group 1 (n=105) and 68.1 years in Group 2 (n=65). Qualified success rates for intraocular pressure <18 mmHg, intraocular pressure <15 mmHg, and intraocular pressure <12 mmHg were similar between the groups (Group 1: 96.2%, 88.6%, and 32.4%, respectively; Group 2: 93.8%, 78.5%, and 21.5%, respectively; all p>0.05). Complete success rates were significantly higher in Group 1 than in Group 2: for intraocular pressure <18 mmHg (76.2% vs. 47.7%), intraocular pressure <15 mmHg (73.3% vs. 40.0%), and intraocular pressure <12 mmHg (14.3% vs. 4.6%). The mean reduction in medication use was higher in Group 1 than in Group 2. At the end of follow-up, 79.0% of eyes in Group 1 and 47.7% of eyes in Group 2 became medication-free. Conclusions: Both groups showed high qualified success rates, but eyes with baseline pharmacologically controlled intraocular pressure <18 mmHg showed higher complete success rates and greater chances of achieving no need for medications.

RESUMO Objetivo: Avaliar os resultados dos implantes de by-pass trabecular como terapia de substituição aos colírios em pacientes com glaucoma de ângulo aberto controlados com medicação vs. não controlados com medicação. Métodos: Este foi um estudo retrospectivo de olhos submetidos a cirurgia de implante de by-pass trabecular de primeira (iStent) ou segunda geração (iStent inject). O Grupo 1 consistiu em olhos com pressão intraocular medicada <18 mmHg e o Grupo 2 consistiu em olhos com pressão intraocular medicada ≥18 mmHg. Os principais desfechos foram as taxas de sucesso relativo (com ou sem medicamentos) e completo (sem medicamentos) em diferentes pressões intraoculares-alvo, redução média (%) no uso de medicamentos e proporção de olhos sem medicamentos. Resultados: A média de idade foi de 70,4 anos no Grupo 1 (n=105) e 68,1 anos no Grupo 2 (n=65). As taxas de sucesso relativo para pressão intraocular <18 mmHg, pressão intraocular <15 mmHg e pressão intraocular <12 mmHg foram semelhantes entre os grupos (Grupo 1: 96,2%, 88,6% e 32,4%, respectivamente; Grupo 2: 93,8%, 78,5% e 21,5%, respectivamente; todos p>0,05). As taxas de sucesso completo foram significativa mente maiores no Grupo 1 do que no Grupo 2: pressão intraocular <18 mmHg (76,2% vs. 47,7%); pressão intraocular <15 mmHg (73,3% vs. 40%); pressão intraocular <12 mmHg (14,3% vs. 4,6%). A redução média no uso de medicamentos foi maior no Grupo 1 do que no Grupo 2. Ao final do acompanhamento, 79,0% dos olhos do Grupo 1 e 47,7% dos olhos do Grupo 2 estavam livres medicamentos. Conclusões: Ambos os grupos mostraram altas taxas de sucesso relativo, mas olhos com pressão intraocular medicada pré-operatória <18 mmHg apresentaram taxas de sucesso completo mais elevadas, bem como maiores chances de se tornarem livres de medicamentos para glaucoma.

Trabecular microbypass as replacement therapy in pharmacologically controlled open-angle glaucoma patients.

PURPOSE: To assess the outcomes of the trabecular bypass as replacement therapy for medications in pharmacologically controlled vs. pharmacologically uncontrolled open-angle glaucoma patients. METHODS: This was a retrospective study of eyes treated with first- (iStent) or second-generation (iStent inject) trabecular bypass. Group 1 consisted of eyes with pharmacologically controlled intraocular pressure <18 mmHg and Group 2 consisted of eyes with pharmacologically controlled intraocular pressure ≥18 mmHg. The main outcomes measured were qualified (with or without medications) and unqualified or complete (without medications) success rates at different target intraocular pressures, mean reduction (%) in medication use, and proportion of medication-free eyes. RESULTS: The mean age was 70.4 years in Group 1 (n=105) and 68.1 years in Group 2 (n=65). Qualified success rates for intraocular pressure <18 mmHg, intraocular pressure <15 mmHg, and intraocular pressure <12 mmHg were similar between the groups (Group 1: 96.2%, 88.6%, and 32.4%, respectively; Group 2: 93.8%, 78.5%, and 21.5%, respectively; all p>0.05). Complete success rates were significantly higher in Group 1 than in Group 2: for intraocular pressure <18 mmHg (76.2% vs. 47.7%), intraocular pressure <15 mmHg (73.3% vs. 40.0%), and intraocular pressure <12 mmHg (14.3% vs. 4.6%). The mean reduction in medication use was higher in Group 1 than in Group 2. At the end of follow-up, 79.0% of eyes in Group 1 and 47.7% of eyes in Group 2 became medication-free. CONCLUSIONS: Both groups showed high qualified success rates, but eyes with baseline pharmacologically controlled intraocular pressure <18 mmHg showed higher complete success rates and greater chances of achieving no need for medications.

Custo-efetividade do uso do dispositivo de by-pass trabecular (iStent® Trabecular MicroBypass) associado a cirurgia de catarata para o tratamento conjunto do glaucoma primário de ângulo aberto e da catarata sob a perspectiva do Sistema de Saúde Suplementar no Brasil / Cost-effectiveness of using the trabecular by-pass device (iStent® Trabecular Micro-Bypass) combined with cataract surgery for the treatment of primary open-angle glaucoma and cataract from the Supplementary Health System perspective in Brazil

Objetivo: Avaliar se a incorporação do implante trabecular iStent® Trabecular Micro-Bypass é custo- -efetiva para o tratamento do glaucoma primário de ângulo aberto (GPAA) em pacientes que serão submetidos a cirurgia de catarata sob a perspectiva do Sistema de Saúde Suplementar no Brasil. Métodos: Foi elaborado um modelo analítico de Markov, cujos custos foram obtidos a partir da perspectiva da saúde suplementar brasileira (custos médicos diretos). A efetividade foi medida em "anos de vida livres de progressão (PFLY)". O horizonte temporal foi a expectativa de vida média da população brasileira. Os dados foram obtidos por meio da revisão e da análise crítica da literatura. O caso base foi: portadores de GPAA e catarata submetidos a cirurgia de catarata isolada e manutenção do uso de colírios antiglaucomatosos. Testou-se se a incorporação do iStent® Trabecular Micro-Bypass nesse cenário seria custo-efetiva. A medida de desfecho foi a razão de custo-efetividade incremental (RCEI: R$/PFLY). Realizou-se análise de sensibilidade univariada e probabilística para testar a robustez do modelo. Resultados: A incorporação do iStent® Trabecular Micro-Bypass gera um aumento dos custos inicialmente, mas melhora o controle da doença, tornando o glaucoma estável por mais tempo e diminuindo os custos futuros relacionados à progressão da doença. A RCEI foi de R$ 5.491,99/PFLY. O modelo mostrou-se robusto nas análises de sensibilidade. Conclusão: Esta análise sugere que a incorporação do implante iStent® Trabecular Micro-Bypass combinado com a cirurgia de catarata seria custo-efetiva para o tratamento conjunto da catarata e do GPAA no cenário da saúde suplementar no Brasil.

Objective: To evaluate whether the incorporation of the iStent® Trabecular Micro-Bypass implant is cost-effective for the treatment of primary open-angle glaucoma (POAG) in patients undergoing cataract surgery from the perspective of the supplementary healthcare system in Brazil. Methods: An analytical Markov model was developed and costs were obtained from the Brazilian supplementary health perspective (direct medical costs). Effectiveness was measured in "progression free life years (PFLY)". The time horizon was the average life expectancy of the Brazilian population. Data were obtained through review and critical analysis of the literature. The base case was: glaucomatous patients with cataract who underwent isolated cataract surgery and continued use of antiglaucomatous eye drops. We tested whether incorporating iStent® Trabecular Micro-Bypass in this scenario would be cost effective. The outcome measure was the incremental cost-effectiveness ratio (ICER: R$/PFLY). We performed univariate and probabilistic sensitivity analyses to test the robustness of the model. Results: Incorporating the iStent® Trabecular Micro-Bypass increases initial costs but improves disease control, making glaucoma stable longer and reducing future costs due to disease progression. The ICER was R$ 5,491.99/PFLY. The model was robust in sensitivity analyses. Conclusion: This analysis suggests that the incorporation of the iStent® Trabecular Micro-Bypass combined with cataract surgery would be cost-effective for joint cataract and POAG treatment in the supplementary health setting in Brazil.

One-Year Comparative Evaluation of iStent or iStent inject Implantation Combined with Cataract Surgery in a Single Center.

INTRODUCTION: This retrospective consecutive case series assessed 12-month effectiveness and safety of iStent® or iStent inject® trabecular micro-bypass implants with cataract surgery in patients with open-angle glaucoma (OAG) in a real-world clinical setting. METHODS: Effectiveness outcomes consisted of intraocular pressure (IOP) reduction; glaucoma medication reduction; proportions of eyes achieving IOP < 18, < 15, or < 12 mmHg; and proportional analysis of medication usage. Safety outcomes included adverse events, secondary surgeries, and best-corrected visual acuity (BCVA). RESULTS: This evaluation included 58 eyes with OAG (35 iStent, 23 iStent inject), with 96.6% of eyes having mild or moderate glaucoma. Diagnoses included primary open-angle glaucoma (the majority; 72.4%), pseudoexfoliative glaucoma, and pigmentary glaucoma. Baseline mean IOP and medications were statistically comparable between groups: 16.1 ± 3.6 mmHg on a mean of 1.8 ± 0.8 medications in the iStent group, and 16.2 ± 3.1 mmHg on a mean of 1.7 ± 0.8 medications in the iStent inject group. Twelve months after stent-cataract surgery, mean IOP was significantly lower in the iStent inject group than in the iStent group (13.1 mmHg vs. 15.4 mmHg, respectively; p < 0.001), and the percent reduction in IOP from baseline was significantly greater in iStent inject eyes than in iStent eyes (19.1% vs. 4.3% reduction, respectively; p < 0.001). At 12 months postoperative, significantly greater proportions of iStent inject eyes than iStent eyes achieved IOP < 18 mmHg (100% vs. 80.0% of eyes, respectively; p = 0.035), IOP < 15 mmHg (73.9% vs. 34.3% of eyes, respectively; p = 0.003), and IOP < 12 mmHg (26.1% vs. 0% of eyes, respectively; p = 0.002). Meanwhile, both groups achieved significant medication reductions at 12 months vs. baseline (94.1% reduction in iStent inject eyes, p < 0.0001; and 72.2% reduction in iStent eyes, p < 0.0001), with the percent reduction being significantly greater in iStent inject eyes than in iStent eyes (p = 0.023). At 12 months, mean number of medications was significantly lower in iStent inject eyes than iStent eyes (0.1 vs. 0.5 medications, respectively; p = 0.021), and significantly more iStent inject eyes (95.7%) than iStent eyes (71.4%) were off medications entirely (p = 0.021). A similarly high safety profile was observed in both groups. CONCLUSION: iStent or iStent inject implantation with cataract surgery resulted in substantial and safe reductions in IOP and medications through 12 months postoperative. Consistent with prior observations, greater efficacy was observed with iStent inject than with iStent. FUNDING: The Rapid Service Fees were funded by Glaukos Corporation.

Avaliação econômica do glaucoma primário de ângulo aberto / Economic evaluation of primary open-angle glaucoma

Resumo Objetivo: Avaliar a relação custo-utilidade do tratamento inicial com laser ou medicamentos do glaucoma primário de ângulo aberto (GPAA) no Brasil, considerando de um lado os custos totais e de outro lado o impacto na qualidade de vida dos pacientes. Métodos: O estudo foi realizado com base em um modelo de Markov, onde uma coorte teórica de portadores de GPAA em estágio inicial foi gerada. Os parâmetros usados no modelo foram obtidos na literatura e incluíram: custos médicos diretos (consultas, exames, tratamento); custos não médicos diretos (gasto com hospedagem, transporte, alimentação, acompanhante); custos indiretos (relacionados à incapacidade para o trabalho); valores de utilidade (qualidade de vida medida em QALY - quality-adjusted life year); e probabilidade de transição entre os estágios de saúde. Três estratégias de tratamento foram testadas no modelo: (1) sem tratamento; (2) tratamento inicial com colírios; (3) tratamento inicial com trabeculoplastia a laser. A medida de desfecho foi a razão de custo-utilidade incremental (RCUI). A robustez do modelo foi testada através de análise de sensibilidade. Resultados: As estratégias (2) e (3) de tratamento inicial do GPAA geraram ganhos em qualidade de vida em relação à (1) no Brasil. Iniciar o tratamento com laser gerou ganho médio de 1 QALY, enquanto que com medicamentos propiciou um ganho de 2 QALYs em média. Dentre as três estratégias testadas, a estratégia (2) foi a custo-efetiva e foi dominante sobre as demais, pois foi ao mesmo tempo a mais barata e a mais efetiva. Conclusão: Tanto a trabeculoplastia a laser quanto os medicamentos como tratamentos primários do GPAA inicial geraram ganhos significativos de qualidade de vida. A estratégia de se iniciar o tratamento com medicações foi custo-efetiva, quando se considera os custos totais. A alternativa de tratamento inicial através de trabeculoplastia a laser não foi custo-efetiva.

Abstract Objective: To evaluate the cost-utility relation of the initial treatment with laser or primary open-angle glaucoma medications (PLA) in Brazil, considering on the one hand the total costs and on the other side the impact on patients' quality of life. Methods: The study was performed based on a Markov model, where a theoretical cohort of early-stage GPAA carriers was generated. The parameters used in the model were obtained in the literature and included: direct medical costs (consultations, examinations, treatment); direct non-medical costs (accommodation, transportation, meals, companions); indirect costs (related to incapacity for work); utility values (quality of life measured in QALY - quality-adjusted life year); and probability of transition between stages of health. Three treatment strategies were tested in the model: (1) without treatment; (2) initial treatment with eye drops; (3) initial treatment with laser trabeculoplasty. The measure of outcome was the incremental cost-utility ratio (RCUI). The robustness of the model was tested through sensitivity analysis. Results: The strategies (2) and (3) of the initial treatment of POAG generated gains in quality of life in relation to (1) in Brazil. Initiating the laser treatment generated an average gain of 1 QALY, whereas with medication it gave a gain of 2 QALYs on average. Among the three strategies tested, strategy (2) was cost-effective and was dominant over the other strategies, since it was at the same time the cheapest and the most effective strategy. Conclusion: Both laser trabeculoplasty and medications as primary treatments of early-stage POAG have generated significant gains in quality of life. The strategy of starting treatment with medications was cost-effective, whereas laser trabeculoplasty strategy was not cost-effective, when non-medical costs (direct and indirect) are included.

Custos não médicos diretos e indiretos relacionados ao glaucoma primário de ângulo aberto no Brasil / Non-medical direct and indirect costs related to primary open-angle glaucoma in Brazil

RESUMO Objetivo: Identificar os custos não médicos diretos e indiretos em uma população de pacientes portadores de glaucoma primário de ângulo aberto (GPAA) em tratamento no Brasil. Métodos: A pesquisa dos custos neste estudo transversal foi realizada através de entrevista a uma população de pacientes portadores de GPAA em acompanhamento em um centro de referência para o tratamento do glaucoma na cidade de Juiz de Fora - MG. Para avaliação dos custos não médicos diretos, as seguintes variáveis foram investigadas: gasto com transporte, hospedagem, alimentação e acompanhante para cada consulta. Já na análise dos custos indiretos, avaliou-se: recebimento ou não de benefício social por causa do glaucoma (aposentadoria ou auxílio-doença) e qual o valor anual e perda de dias trabalhados pelo paciente e/ou pelo acompanhante. Os valores médios anuais foram calculados para todo o grupo e para cada estágio evolutivo do glaucoma. Resultados: Setenta e sete pacientes foram incluídos nesta análise (GPAA inicial: 26,0%; GPAA moderado: 24,7% e GPAA avançado: 49,3%). A média do custo não médico direto foi (em reais): 587,47; 660,52 e 708,54 para os glaucomas iniciais, moderados e avançados, respectivamente. Já a média do custo indireto foi: 20.156,75 (GPAA inicial); 26.988,16 (moderado) e 27.263,82 (avançado). Conclusão: Os custos não médicos diretos e indiretos relacionados ao GPAA no Brasil foram identificados. Os custos indiretos são superiores aos custos não médicos diretos e ambos tendem a aumentar com o avanço da doença.

ABSTRACT Objective: To identify direct and indirect non-medical costs in a population of patients with primary open-angle glaucoma (POAG) receiving treatment in Brazil. Methods: In this cross-sectional study, we obtained the costs through an interview with a population of patients with POAG at a glaucoma referral clinic in the city of Juiz de Fora - MG. In order to assess the direct non-medical costs, we investigated the following variables transportation expenses, lodging expenses, food and companion expenses for each visit. In the indirect costs analysis, we assessed the following variables: whether or not social benefits were received because of glaucoma (retirement or sickness benefit) and the annual value and loss of days worked by the patient and/or the companion. We calculated the mean annual values for the whole group and for each glaucoma stage. Results: Seventy-seven patients were included in this analysis (initial POAG: 26.0%, moderate POAG: 24.7% and advanced POAG 49.3%). The mean non-medical direct cost was (in reais): 587.47; 660.52 and 708.54 for the initial, moderate and advanced glaucomas, respectively. The mean indirect cost was: 20,156.75 (initial POAG); 26,988.16 (moderate POAG) and 27,263.82 (advanced POAG). Conclusion: We identified the direct and indirect non-medical costs related to POAG in Brazil. Indirect costs are higher than non-medical direct costs and both tend to increase with disease progression.

Intermediate Results of iStent or iStent inject Implantation Combined with Cataract Surgery in a Real-World Setting: A Longitudinal Retrospective Study.

INTRODUCTION: In this real-world, retrospective, comparative study we evaluated 6-month performance and safety in consecutive eyes following implantation of the iStent® or iStent inject® trabecular micro-bypass device with concomitant cataract surgery. METHODS: Performance outcomes included intraocular pressure (IOP) reduction; glaucoma medication reduction; proportions of eyes achieving an IOP of < 18, < 16, < 14, or < 12 mmHg; and proportions of eyes on 0, 1, 2, or ≥ 3 medications. Safety outcomes included adverse events, secondary surgeries, and best-corrected visual acuity (BCVA). RESULTS: A total of 73 eyes with open-angle glaucoma and cataract were included in the study; of these, 38 eyes were implanted with the iStent device and 35 were implanted with the iStent inject device. The two groups of patients had similar baseline characteristics, with the exception of mean age and medication burden (both higher in patients receiving the iStent inject device); over 90% of eyes in both groups had early glaucoma. At 6 months after surgery, mean IOP had fallen from 16.5 ± 3.9 to 13.9 ± 2.3 mmHg in eyes with the iStent implant (p < 0.001), and from 17.3 ± 3.0 to 12.7 ± 1.8 mmHg in those with the iStent inject implant (p < 0.001). This reduction was significantly greater in the iStent inject eyes than in the iStent eyes (26.6 vs. 15.8%) (p = 0.005). Significantly more eyes receiving the iStent inject device compared to the iStent device achieved an IOP of < 18 mmHg at 6 months post surgery (100 vs. 86.8%) (p = 0.033). Average medication usage was reduced from 1.8 to 0.4 medications in iStent eyes (p < 0.001) and from 2.3 to 0.4 medications in iStent inject eyes (p < 0.001). Over 70% of eyes in both groups became medication-free by 6 months post implantation. Adverse events in iStent eyes were mild and resulted in no sequelae; two iStent eyes underwent non-penetrating deep sclerectomy during follow-up. No complications or secondary surgeries were noted in iStent inject eyes. All eyes in both groups maintained or showed improved BCVA versus baseline. CONCLUSION: Significant and safe IOP and medication reductions were observed after iStent or iStent inject implantation with concomitant cataract surgery. Trends toward greater effectiveness and fewer adverse events were observed with the iStent inject device compared with the iStent device. FUNDING: Article processing charges were provided by Glaukos Corporation.

Maximizing cost-effectiveness by adjusting treatment strategy according to glaucoma severity.

BACKGROUND: The aim of this study is to determine the most cost-effective strategy for the treatment of primary open-angle glaucoma (POAG) in Brazil, from the payer's perspective (Brazilian Public Health System) in the setting of the Glaucoma Referral Centers. METHODS: Study design was a cost-effectiveness analysis of different treatment strategies for POAG. We developed 3 Markov models (one for each glaucoma stage: early, moderate and advanced), using a hypothetical cohort of POAG patients, from the perspective of the Brazilian Public Health System (SUS) and a horizon of the average life expectancy of the Brazilian population. Different strategies were tested according to disease severity. For early glaucoma, we compared observation, laser and medications. For moderate glaucoma, medications, laser and surgery. For advanced glaucoma, medications and surgery. Main outcome measures were ICER (incremental cost-effectiveness ratio), medical direct costs and QALY (quality-adjusted life year). RESULTS: In early glaucoma, both laser and medical treatment were cost-effective (ICERs of initial laser and initial medical treatment over observation only, were R$ 2,811.39/QALY and R$ 3,450.47/QALY). Compared to observation strategy, the two alternatives have provided significant gains in quality of life. In moderate glaucoma population, medical treatment presented the highest costs among treatment strategies. Both laser and surgery were highly cost-effective in this group. For advanced glaucoma, both tested strategies were cost-effective. Starting age had a great impact on results in all studied groups. Initiating glaucoma therapy using laser or surgery were more cost-effective, the younger the patient. CONCLUSION: All tested treatment strategies for glaucoma provided real gains in quality of life and were cost-effective. However, according to the disease severity, not all strategies provided the same cost-effectiveness profile. Based on our findings, there should be a preferred strategy for each glaucoma stage, according to a cost-effectiveness ratio ranking.

Custo-efetividade no glaucoma. Conceitos, resultados e perspectiva atual / Cost-effectiveness in glaucoma. Concepts, results and current perspective

RESUMO O glaucoma é a principal causa de cegueira irreversível no Brasil. Sua prevalência e incidência tendem a aumentar significativamente no futuro, principalmente devido ao aumento da população e ao seu envelhecimento. A escassez de recursos para a saúde associada ao aumento da disponibilidade e dos custos das tecnologias em saúde exige uma análise parametrizada destas tecnologias e uma alocação eficiente dos recursos. Os estudos de custo-efetividade e custo-utilidade são importantes, pois permitem uma comparação entre diferentes alternativas tanto em termos de seus custos quanto de seus resultados. Para isto, modelos matemáticos (como modelagem de Markov) são comumente utilizados como método de análise. Existem na literatura muitas evidências de custoefetividade e custo-utilidade no glaucoma, inclusive no Brasil. Este artigo se propõe a revisar de maneira prática os conceitos de avaliação econômica em saúde, os tipos de estudos econômicos em saúde, bem como os resultados dos estudos de custo-efetividade e custo-utilidade na área de glaucoma na literatura.

ABSTRACT Glaucoma is the leading cause of irreversible blindness in Brazil. Its prevalence and incidence tend to increase significantly in the future, mainly due to the population increase and aging. The scarcity of health care resources and the increasing costs in health require a balanced analysis of health interventions and an efficient allocation of resources. The cost-effectiveness and cost-utility studies are important because they allow a comparison between different alternatives in terms of both their costs and their results. For this purpose, mathematical modeling (such as Markov modeling) is commonly used as the analytical method. The literature, including in Brazil, has plenty of evidence of cost-effectiveness and cost-utility in glaucoma. This article aims to review in a practical way the concepts of economic evaluation in health, describe the different types of health economic studies, as well as the results of cost-effectiveness and cost-utility studies in glaucoma in the literature.

Custo-utilidade do tratamento do glaucoma primário de ângulo aberto no Brasil / Cost-utility of primary open-angle glaucoma in Brazil

RESUMO Objetivo: Determinar a estratégia mais custo-efetiva para o tratamento do glaucoma primário de ângulo aberto em fase inicial, comparando-se as seguintes alternativas: observação, tratamento clínico ou tratamento com laser. Métodos: Por meio de um modelo de Markov, sob a perspectiva do Sistema Único de Saúde (SUS) e um horizonte da expectativa de vida média da população brasileira. Comparou-se a razão de custo-utilidade incremental (ICUR) entre 3 alternativas de tratamento, assim como seus custos e o ganho em qualidade de vida, medido em QALY (Quality-adjusted life years). Resultados: A ICUR do tratamento inicial com laser e do tratamento inicial com colírios, em relação a não tratar foi de R$ 2.811,39/QALY e R$ 3.450,47/QALY, respectivamente. Ambas as estratégias foram custo-efetivas, com uma discreta vantagem para o tratamento a laser. Esta diferença diminui ainda mais quando se aumenta a idade de entrada no modelo. As duas alternativas propiciaram ganhos significativos de qualidade de vida (em torno de 2,5 QALYs para o tratamento com laser e de 5,0 QALYs para o tratamento com colírios). Conclusão: Tanto o tratamento primário com trabeculoplastia a laser quanto com medicações foram custo-efetivos e proporcionaram ganhos reais de qualidade de vida quando comparados com o não tratamento do GPAA.

ABSTRACT Objective: To determine the most cost-effective strategy for the treatment of early-stage primary open-angle glaucoma, by comparing the following alternatives: observation, medical therapy or laser treatment. Methods: Using a Markov model, from the perspective of the Brazilian Public Health System (SUS) and a horizon of the average life expectancy of the Brazilian population, we compared the incremental cost-utility ratio (ICUR) among the three treatment alternatives, as well as their costs and the gain in quality of life as measured in QALYs (Quality-adjusted life years). Results: The ICUR of initial laser treatment and initial medical treatment over observation only, was R$ 2,811.39/QALY and R$ 3,450.47/QALY, respectively. Both strategies were cost-effective, with a slight advantage for the laser treatment. This difference decreases further when increasing age into the model. The two alternatives have provided significant gains in quality of life (around 2.5 QALYs for the laser treatment and 5.0 QALYs for treatment with eye drops). Conclusion: Both primary treatments, with laser trabeculoplasty as well as with medications, were cost-effective and provided real gains in quality of life when compared with no treatment of POAG.

Percepção do paciente portador de glaucoma e os diferentes tipos de tratamento (clínico versus cirúrgico) / Patient’s perception on glaucoma and different types of treatment (medical versus surgical treatment)

Objetivo: Identificar a percepção dos pacientes sobre o significado de ser portador de glaucoma e a percepção que tem sobre o tratamento clínico ou cirúrgico. Métodos: Para a coleta dos dados utilizou-se a pesquisa qualitativa através da estratégia de grupos focais realizados com pacientes em tratamento clínico (grupo 1) e pacientes submetidos à cirurgia antiglaucomatosa (grupo 2). A análise e a interpretação dos resultados foram feitas pela técnica da análise de conteúdo. Resultados: O medo da cegueira e a desinformação sobre a doença foram os aspectos negativos mais encontrados com relação a ser portador de glaucoma. O grupo cirúrgico preferiu a situação atual quando comparada à necessidade do uso de medicação. Verificou-se que tanto o glaucoma quanto o seu tratamento impactaram profundamente esses pacientes e que, embora a preocupação com a doença ainda persista, os pacientes operados demonstraram apresentar menos impacto no seu cotidiano. Foram determinantes para a aceitação da indicação da cirurgia a falta de controle da doença e a confiança no médico, sendo esta última considerada um fator primordial nos dois grupos pesquisados, o que aponta para sua importância, independente da decisão tomada pelo paciente na convivência com sua doença. Conclusão: Identificaram-se os aspectos negativos mais relevantes com relação ao glaucoma e ao seu tratamento. A confiança na correta indicação do tipo de tratamento, clínico ou cirúrgico, e uma relação sólida entre o paciente e o médico são os fatores determinantes para uma maior tranquilidade dos pacientes em tratamento de glaucoma (clínico ou cirúrgico).

Objective: To identify the meaning and impact on their quality of life of having glaucoma and to understand the patients’ perception on the different types of treatment (medical or surgical). Methods: Through a qualitative research, focus groups were conducted with patients in clinical treatment (group 1) and patients who underwent glaucoma surgery in both eyes and were without medication (group 2). The responses were analyzed using the technique of content analysis. Results: Fear of blindness and lack of information about the disease were the most cited issues in relation to how it is like to having glaucoma. Medication costs, impact of drops on patients’ daily lives and the side effects were the main points discussed in relation to medical treatment. All patients in the surgical group preferred the current situation (without medication) when compared to the need for chronic use of medication. In the two groups, both glaucoma and its treatment had a profound impact on people, not only from a psychological standpoint, but also affecting their daily lives. Patients operated on for glaucoma appear to have less impact on their daily lives, but the concern about the disease persists. Conclusion: We identified the most significant negative aspects of glaucoma and its treatment from patients’ perspectives. Confidence in the correct indication of the type of treatment, clinical or surgical, and a solid relationship between the patient the doctor are determining factors for extra peace of mind of patients being treated for glaucoma.

Nível de conhecimento sobre glaucoma primário de ângulo aberto entre os estudantes de medicina / Knowledge about primary open angle glaucoma among medical students

Objetivo: Avaliar o conhecimento dos alunos de graduação do curso de Medicina da Universidade Federal de Juiz de Fora em relação ao glaucoma primário de ângulo aberto. Métodos: Neste estudo transversal, aplicou-se aos alunos dos 5º e 6º ano um questionário contendo 11 questões referentes a epidemiologia, fatores de risco, sintomas, diagnóstico, tratamento, consequências do glaucoma e por último se consideram os conhecimentos adquiridos na universidade como suficientes. Características dos alunos (idade, sexo, especialidade pretendida) foram identificadas. Resultados: Entre os estudantes, 52,9% eram mulheres. A origem genética da doença foi identificada por 22,5%. Quase a metade (46,1%) não sabia que o glaucoma na maioria das vezes é assintomático. Aproximadamente 1 em cada 3 alunos não sabia que a cegueira do glaucoma era irreversível. A grande maioria (91,2%) identificou corretamente que a tonometria era um exame importante na avaliação do glaucoma e que o tratamento poderia ser clínico (70,6%) ou cirúrgico (71,6%). Porém, poucos alunos deram a real importância para os exames de fundoscopia (35,3%) e campimetria (28,7%). Quase a totalidade (95,1%) dos entrevistados considerou o próprio conhecimento como insuficiente. Conclusão: A maioria dos entrevistados acha que o conhecimento sobre glaucoma primário de ângulo aberto adquirido na graduação é insuficiente. Tal desconhecimento pode levar a oportunidades de diagnóstico perdidas e gerar consequências graves tanto do ponto de vista individual (cegueira) quanto do ponto de vista coletivo (impacto para o sistema de saúde e sociedade). .

Objective: To assess the knowledge of primary open-angle glaucoma among medical students from Federal University of Juiz de Fora. Methods: In this cross sectional study, we conducted a survey among students attending the last two years of Medical School. The questionnaire consisted in 11 questions about epidemiology, risk factors, symptoms, diagnosis, treatment and primary openangle glaucoma (POAG) consequences. The students were also asked if they considered their knowledge about POAG sufficient. Students’ characteristics (age, sex and intended area of specialization) were identified. Results: Women comprised 52.9% of the students. Only 22.5% identified POAG as having a genetic origin. Almost half of them (46.1%) did not know that POAG is asymptomatic and 1 out of 3 students did not know that glaucoma blindness is irreversible. The great majority (91.2%) correctly identified tonometry as an important tool for diagnosis and that glaucoma can be treated through medications (70.6%) or surgery (71.6%). However, few students identified fundoscopy (35.3%) and perimetry (28.7%) as important tools for glaucoma assessment. Almost everyone (95.1%) considered their knowledge insufficient. Conclusion: The majority of the participants believe that their knowledge of POAG is insufficient. This gap can lead to some serious consequences from both individual (blindness) and collective (negative impact in health system and society) perspectives. .

Quality of life of medically versus surgically treated glaucoma patients.

PURPOSE: To assess and compare the impact of medical and surgical glaucoma treatments on patients' health-related Quality of Life (QoL). MATERIALS AND METHODS: We used the 25-question version of the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) for this cross-sectional study. Patients were divided into 3 groups: 1 (medical treatment); 2 (surgical treatment), and 3 (medical and surgical treatment). Comparisons among groups were carried out for demographic and clinical characteristics and for the NEI VFQ-25 scores. RESULTS: Of the 240 invited patients, 225 were enrolled for this study. Groups were homogenous for age, sex, race, type of glaucoma, and level of education. The mean overall score was 78.46, 65.85, and 60.51 for groups 1, 2, and 3, respectively (P<0.001). Type of therapy, visual acuity, and comorbidity were associated with QoL scores. When controlled by glaucoma stages, surgery had a negative impact on the QoL only in early glaucoma. CONCLUSIONS: Glaucoma surgery is associated with a lower QoL in patients with early glaucoma due mainly to the psychological burden. In moderate and advanced glaucomas, the QoL scores did not differ between the surgical and the medical therapy groups.

Quality of life of glaucoma patients under medical therapy with different prostaglandins.

PURPOSE: To assess the quality of life of glaucoma patients under medical therapy with different prostaglandin analogs. METHODS: A cross-sectional study of consecutive glaucoma patients was designed. We assessed the patients' quality of life through the Brazilian 25-question version of the National Eye Institute Visual Functioning Questionnaire, comprising 12 subscales (general health, general vision, ocular pain, near vision, distance vision, social function, mental health, role limitations, dependency, driving, color vision, and peripheral vision) and a total composite score. Clinical features, including current medical treatment, were obtained from each patient's medical record. Three groups of patients were identified according to the prostaglandin in use: bimatoprost, latanoprost, or travoprost. The main outcome measures were: mean score in each subscale and mean total composite score. RESULTS: The mean total composite score for the whole group was 70.60. The bimatoprost, latanoprost, and travoprost groups had the following mean composite scores, respectively: 56.56, 77.36, and 71.08 (P = 0.001, analysis of variance [ANOVA]). Latanoprost and travoprost results were similar, and both were superior to bimatoprost. Most subscales had similar results. The subscale with the lowest score for all groups was general health. Groups were homogenous and comparable. CONCLUSION: There is a difference in the quality of life between glaucoma patients using prostaglandin analogs. It seems that bimatoprost users have lower QoL when compared to latanoprost and travoprost users.

Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS).

PURPOSE: Non-penetrating deep sclerectomy (NPDS) has emerged as a viable option in the surgical management of open-angle glaucoma. Our aim is to assess the cost-effectiveness of NPDS and to compare it to maximum medical treatment in a 5-year follow-up. METHODS: A decision analysis model was built. Surgical (NPDS) arm of the decision tree was observational (consecutive retrospective case series) and maximum medical treatment arm was hypothetical. Maximum medical therapy was considered a three-drug regimen (association of a fixed combination of timolol/dorzolamide [FCTD] and a prostaglandin analogue [bimatoprost, latanoprost or travoprost]). Cost-effectiveness ratio was defined as direct cost (US dollars) for each percentage of intraocular pressure (IOP) reduction. Horizon was 5 years and perspective is from the public health care service in Brazil (SUS). Incremental cost-effectiveness ratio (ICER) was calculated. RESULTS: Direct cost for each percentage of IOP reduction in 5 years (cost-effectiveness ratio) was US$ 10.19 for NPDS; US$ 37.45 for the association of a FCTD and bimatoprost; US$ 39.33 for FCTD and travoprost; and US$ 41.42 for FCTD and latanoprost. NPDS demonstrated a better cost-effectiveness ratio, compared to maximum medical therapy. The ICER was negative for all medical treatment options; therefore NPDS was dominant. CONCLUSIONS: Despite some limitations, NPDS was both less costly and more effective than maximum medical therapy. From the Brazilian public health perspective, it was the most cost-effective treatment option when compared to maximum medical therapy (FCTD and prostaglandin).

Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS) / Comparação de custo-efetividade entre a esclerectomia profunda não penetrante e a terapia clínica máxima tolerada para o glaucoma no Sistema Único de Saúde (SUS)

PURPOSE: Non-penetrating deep sclerectomy (NPDS) has emerged as a viable option in the surgical management of open-angle glaucoma. Our aim is to assess the cost-effectiveness of NPDS and to compare it to maximum medical treatment in a 5-year follow-up. METHODS: A decision analysis model was built. Surgical (NPDS) arm of the decision tree was observational (consecutive retrospective case series) and maximum medical treatment arm was hypothetical. Maximum medical therapy was considered a three-drug regimen (association of a fixed combination of timolol/dorzolamide [FCTD] and a prostaglandin analogue [bimatoprost, latanoprost or travoprost]). Cost-effectiveness ratio was defined as direct cost (US dollars) for each percentage of intraocular pressure (IOP) reduction. Horizon was 5 years and perspective is from the public health care service in Brazil (SUS). Incremental cost-effectiveness ratio (ICER) was calculated. RESULTS: Direct cost for each percentage of IOP reduction in 5 years (cost-effectiveness ratio) was US$ 10.19 for NPDS; US$ 37.45 for the association of a FCTD and bimatoprost; US$ 39.33 for FCTD and travoprost; and US$ 41.42 for FCTD and latanoprost. NPDS demonstrated a better cost-effectiveness ratio, compared to maximum medical therapy. The ICER was negative for all medical treatment options; therefore NPDS was dominant. CONCLUSIONS: Despite some limitations, NPDS was both less costly and more effective than maximum medical therapy. From the Brazilian public health perspective, it was the most cost-effective treatment option when compared to maximum medical therapy (FCTD and prostaglandin).

OBJETIVO: A esclerectomia profunda não penetrante (EPNP) é uma opção viável para o tratamento cirúrgico do glaucoma de ângulo aberto. O objetivo deste estudo é avaliar a relação custo-efetividade da EPNP e compará-la com terapia clínica máxima (TCM) em um acompanhamento de 5 anos. MÉTODOS: Um modelo de análise de decisão foi proposto comparando-se o tratamento cirúrgico (EPNP) versus a TCM. A avaliação da EPNP foi observacional retrospectiva de uma série consecutiva de casos e da TCM foi hipotética. A TCM foi considerada como o uso de três drogas (associação de uma combinação fixa de timolol/dorzolamida [CFTD] e um análogo de prostaglandina [bimatoprosta, latanoprosta ou travoprosta]). A relação custo-efetividade foi definida com o custo direto (em dólares) para cada porcentual de redução da pressão intraocular (PIO). A razão de custo-efetividade incremental (ICER) foi calculada. O seguimento foi de 5 anos e a perspectiva dos custos é do Sistema Único de Saúde (SUS). RESULTADOS: O custo direto para cada porcentual de redução da PIO ao final de 5 anos (relação custo-efetividade) foi de US$ 10,19 para a EPNP; US$ 37,45 para a CFTD + bimatoprosta; US$ 39,33 para CFTD + travoprosta; e US$ 41,42 para CFTD + latanoprosta. A EPNP apresentou uma melhor relação custo-efetividade, quando comparada com a TCM. O índice ICER foi negativo, portanto a EPNP foi a opção terapêutica dominante. CONCLUSÃO: A EPNP foi menos custosa e mais efetiva que a TCM. Do ponto de vista do SUS, ela foi a opção mais custo-efetiva, quando comparada com a TCM.

Resources use, costs and effectiveness of non-penetrating deep sclerectomy according to glaucoma stage / Utilização de recursos, custos e efetividade da esclerectomia profunda não penetrante de acordo com a gravidade do glaucoma

PURPOSE: To assess the resources use, costs and effectiveness of non-penetrating deep sclerectomy (NPDS). METHODS: A retrospective cohort of NPDS patients was analyzed. Eyes were stratified according to glaucoma severity into 3 groups: 1 (early), 2 (moderate) and 3 (severe). NPDS associated resources were based on the frequency of the following variables: surgical procedure (NPDS), intraoperative mitomycin C (MMC); 5-fluorouracil needling (5-FU); Nd:YAG laser goniopuncture; new filtering surgery and medications needed postoperatively. Costs were based on the value and prices of the Brazilian Public Health System and follow-up period was 5 years. Success rate: percentage of patients achieving an end-point intraocular pressure <18 mmHg (and least 20 percent reduction) without any medications. RESULTS: Percentage of patients using resources in groups 1, 2 and 3 was, respectively: 92.1 percent, 88.5 percent and 93.0 percent for MMC; 10.5 percent, 11.5 percent and 13.3 percent for 5-FU; 18.4 percent, 19.7 percent and 21.9 percent for goniopuncture and 13.2 percent, 24.6 percent and 27.3 percent for a new surgery. Mean number of glaucoma medications per patient at the end of follow-up was 0.42 in group 1 and 0.48 and 0.73 in groups 2 and 3, respectively. Mean NPDS direct cost was US$305.25, US$361.37 and US$390.09 in early, moderate and severe glaucoma, respectively. No differences were found in effectiveness according to glaucoma severity. CONCLUSION: There is a trend in the use of resources and costs in NPDS. The more advanced the glaucoma, the higher the need for resources and the higher the associated costs. NPDS effectiveness did not differ among different glaucoma stages.

OBJETIVO: Avaliar a utilização de recursos, os custos e a efetividade da esclerectomia profunda não penetrante (EPNP). MÉTODOS: Foi realizado um estudo retrospectivo consecutivo de olhos operados de glaucoma pela técnica de EPNP. Os olhos foram divididos em três grupos de acordo com a gravidade do glaucoma: 1 (inicial), 2 (moderado) e 3 (avançado). Os recursos considerados foram baseados nas seguintes variáveis: procedimento cirúrgico (EPNP), uso de mitomicina C (MMC) intraoperatória, agulhamento com 5-fluoruracil (5-FU), goniopuntura com Nd:YAG laser, nova cirurgia filtrante e medicações necessárias no pós-operatório. O cálculo dos custos foi baseado nos valores exercidos pelo Sistema Único de Saúde (SUS) no período de 5 anos. O sucesso foi considerado uma pressão intraocular final <18 mmHg (com pelo menos 20 por cento de redução) sem qualquer medicação anti-glaucomatosa. RESULTADOS: A utilização proporcional de recursos nos grupos 1, 2 e 3 foi, respectivamente: 92,1 por cento, 88,5 por cento e 93,0 por cento para MMC; 10,5 por cento, 11,5 por cento e 13,3 por cento para 5-FU; 18,4 por cento, 19,7 por cento e 21,9 por cento para goniopuntura e 13,2 por cento, 24,6 por cento e 27,3 por cento para nova cirurgia filtrante. O custo direto da EPNP foi de US$305,25 para os glaucomas iniciais; US$361,37 para os moderados e US$390,09 para os avançados. Não foi observada diferença na efetividade da cirurgia nos três grupos. CONCLUSÃO: Observou-se uma tendência na utilização dos recursos e no custo direto da EPNP. Quanto mais avançado o glaucoma, maior foi a necessidade de recursos e maiores foram os custos. A efetividade da EPNP não sofreu influência do estágio evolutivo do glaucoma.

Resources use, costs and effectiveness of non-penetrating deep sclerectomy according to glaucoma stage.

PURPOSE: To assess the resources use, costs and effectiveness of non-penetrating deep sclerectomy (NPDS). METHODS: A retrospective cohort of NPDS patients was analyzed. Eyes were stratified according to glaucoma severity into 3 groups: 1 (early), 2 (moderate) and 3 (severe). NPDS associated resources were based on the frequency of the following variables: surgical procedure (NPDS), intraoperative mitomycin C (MMC); 5-fluorouracil needling (5-FU); Nd:YAG laser goniopuncture; new filtering surgery and medications needed postoperatively. Costs were based on the value and prices of the Brazilian Public Health System and follow-up period was 5 years. Success rate: percentage of patients achieving an end-point intraocular pressure <18 mmHg (and least 20% reduction) without any medications. RESULTS: Percentage of patients using resources in groups 1, 2 and 3 was, respectively: 92.1%, 88.5% and 93.0% for MMC; 10.5%, 11.5% and 13.3% for 5-FU; 18.4%, 19.7% and 21.9% for goniopuncture and 13.2%, 24.6% and 27.3% for a new surgery. Mean number of glaucoma medications per patient at the end of follow-up was 0.42 in group 1 and 0.48 and 0.73 in groups 2 and 3, respectively. Mean NPDS direct cost was US$305.25, US$361.37 and US$390.09 in early, moderate and severe glaucoma, respectively. No differences were found in effectiveness according to glaucoma severity. CONCLUSION: There is a trend in the use of resources and costs in NPDS. The more advanced the glaucoma, the higher the need for resources and the higher the associated costs. NPDS effectiveness did not differ among different glaucoma stages.

Avaliação econômica das associações fixas de prostaglandina/prostamida e timolol no tratamento do glaucoma e da hipertensão ocular / Economic evaluation of prostaglandin/prostamide and timolol fixed combinations in the treatment of glaucoma and ocular hypertension

OBJETIVO: Avaliar o custo ao final de 5 anos, a efetividade e a relação custo-efetividade das associações fixas de prostaglandina ou prostamida com timolol 0,5 por cento para o tratamento do glaucoma e da hipertensão ocular no Estado de Minas Gerais, Brasil. MÉTODOS: Este estudo transversal avaliou as seguintes associações fixas: bimatoprosta/timolol 0,5 por cento (BT), latanoprosta/timolol 0,5 por cento (LT) e travoprosta/timolol 0,5 por cento (TT). O custo foi calculado a partir do número médio de gotas de 5 frascos de cada associação, da duração (dias) e do preço máximo ao consumidor (PMC). A efetividade na redução da pressão intraocular (PIO) foi obtida na literatura. Para cada uma das associações, calculou-se o custo diário, mensal, anual e em 5 anos. A relação custo-efetividade foi definida como o custo em 5 anos de cada percentual de redução da PIO. RESULTADOS: O PMC, número médio de gotas por frasco e a duração média (dias) foram, respectivamente: R$ 83,07; 109,4 e 54,7 para BT; R$ 126,03; 97,0 e 48,5 para LT e R$ 97,47; 96 e 48,0 para TT. A capacidade de redução percentual da PIO encontrada na literatura foi 35,10 por cento para BT, 35,00 por cento para LT e 34,70 por cento para TT. O custo em 5 anos para cada percentual de redução da PIO foi de R$ 61,02 para BT, R$ 104,71 para LT e R$ 82,53 para TT. A associação BT é dominante sobre as demais. CONCLUSÕES: BT apresentou em 5 anos menor custo e maior efetividade que LT e TT.

PURPOSE:To assess the 5-year cost, effectiveness and costeffectiveness of fixed combinations of prostaglandin or prostamide and timolol 0. 5 percent on glaucoma and/or ocular hypertension in the state of Minas Gerais, Brazil. METHODS: This cross-sectional study evaluated the following fixed combinations: bimatoprost/timolol 0. 5 percent (BT), latanoprost/timolol 0. 5 percent (LT) and travoprost/ timolol 0. 5 percent (TT). Cost was obtained through mean number of drops in a sample of 5 containers of each medication, duration (days) and the average wholesale price (AWP). Effectiveness in reducing intraocular pressure IOP was derived from the literature. Daily, monthly, annually and 5-year cost was calculated. Costeffectiveness was defined as cost by each percentage of IOP reduction over 5 years. RESULTS: AWP, mean number of drops and mean duration (days) were: R$ 83. 07; 109. 4 and 54. 7 for BT; R$ 126. 03; 97. 0 and 48. 5 for LT and R$ 97. 47; 96. 0 and 48. 0 for TT. Mean percentage of IOP reduction, obtained from literature, was: 35. 10 percent for BT, 35. 00 percent for LT and 34. 70 percent for TT. Cost-effetiveness ratio (R$/ percent) was: 61. 02 for BT, 104. 71 for LT and 82. 53 for TT. BT was dominant over LT and TT. CONCLUSION: BT presented lower costs and better effectiveness when compared to LT and TT. The most cost-effective fixed combination was BT.

Does phacoemulsification affect the long-term success of non-penetrating deep sclerectomy?

BACKGROUND AND OBJECTIVE: Phaco non-penetrating deep sclerectomy (PhacoNPDS) is an option to simultaneously treat cataract and glaucoma. The authors assessed tensional success of PhacoNPDS and NPDS up to 3 years of follow-up. PATIENTS AND METHODS: A longitudinal consecutive retrospective study was conducted comparing 376 eyes undergoing NPDS (group 1) and 87 eyes undergoing PhacoNPDS (group 2). Success was defined as complete 1 (intraocular pressure [IOP] < 21 mm Hg without medication); complete 2 (at least a 20% reduction of preoperative IOP without medication), and qualified (IOP < 21 mm Hg with or without medication). RESULTS: Preoperative IOP and number of medications were 23.7 and 2.7 in group 1 and 23.1 and 2.6 in group 2, respectively. Postoperative IOP (3 years) was 13.1 mm Hg in group 1 and 13.4 mm Hg in group 2 (P = .000). Complete 1, complete 2, and qualified success in 3 years were 57.5%, 53.7%, and 94.5% in group 1 and 56.1%, 56.1%, and 100% in group 2, respectively (P = .861, .772, and .159). Final number of medications was 0.5 in group 1 and 0.3 in group 2. CONCLUSION: PhacoNPDS seems to achieve similar tensional results as NPDS alone up to 3 years of follow-up.