Glaucoma Treatment: Prostaglandin Analogs, Topical Beta-Blockers, Laser Trabeculoplasty, and Filtering Surgery

Glaucoma is one of the leading causes of irreversible blindness worldwide. Its management focuses on reducing intraocular pressure (IOP) to prevent progressive optic nerve damage. Treatment options include glaucoma treatment with hypotensive medications, laser procedures, and filtering surgery. This article reviews current and emerging strategies in glaucoma treatment, emphasizing the importance of a personalized approach for each patient.
Treatment Options
Pharmacological treatment remains the first line of defense in glaucoma management. Prostaglandin analogs such as bimatoprost, latanoprost, and travoprost are highly effective in reducing IOP, although topical beta-blockers like timolol are also widely used due to their efficacy and cost [1]. However, prolonged use of preservative-containing medications like benzalkonium chloride can lead to ocular surface diseases, which has driven the development of preservative-free formulations [2].
Selective laser trabeculoplasty (SLT) has emerged as a safe and effective alternative to medical therapy, especially in patients with ocular hypertension and open-angle glaucoma. Recent studies suggest that SLT may be as effective as medications in controlling IOP, with fewer adverse effects and a reduced need for surgery [3].
In cases where medical treatment and laser therapy are insufficient, filtering surgery such as trabeculectomy remains the gold standard. However, newer procedures like the MicroShunt are being evaluated for their comparative efficacy and safety [4]. The choice of surgical procedure depends on multiple factors, including the severity of glaucoma and the patient's response to previous treatments.
Conclusions
Managing glaucoma requires a multidisciplinary and personalized approach. The combination of hypotensive medications, laser procedures, and filtering surgery offers a robust arsenal for controlling IOP and preventing disease progression. Ongoing research and innovation in treatments, such as preservative-free formulations and new surgical techniques, are essential for improving long-term outcomes and the quality of life for patients with glaucoma.
Referencias
- [1] Comparative Effectiveness of First-Line Medications for Primary Open-Angle Glaucoma: A Systematic Review and Network Meta-analysis
- [2] Preservatives and ocular surface disease: A review
- [3] Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial
- [4] Ab-Externo MicroShunt versus Trabeculectomy in Primary Open-Angle Glaucoma: One-Year Results from a 2-Year Randomized, Multicenter Study
Created 6/1/2025