A new approach for the management of primary angle-closure glaucoma after EAGLE trial

Muñoz Negrete, F.J.; Azuara-Blanco, A.

doi:10.1016/j.oftale.2017.03.020

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Muñoz Negrete, A. Azuara-Blanco" "autores" => array:2 [ 0 => array:4 [ "nombre" => "F.J." "apellidos" => "Muñoz Negrete" "email" => array:1 [ 0 => "franciscojmunoz@telefonica.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Azuara-Blanco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centre for Public Health, Queen's University, Belfast, United Kingdom" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nuevo abordaje para el tratamiento del glaucoma por cierre angular primario tras el estudio EAGLE" ] ] "textoCompleto" => "According to the World Health Organisation glaucoma is the leading cause of irreversible blindness.<a class="elsevierStyleCrossRef" href="#bib0030">1</a> Approximately 4 million people are blinded by this condition, and the vast majority are in low-income countries.<a class="elsevierStyleCrossRef" href="#bib0035">2</a> In Spain glaucoma is probably the second leading cause of blindness, after age-related macular degeneration. Although with timely treatment most people with glaucoma do not become blind, many have substantially impaired quality of life due to restricted peripheral vision and the need for long-term treatment.Primary (chronic) angle-closure glaucoma is less common but more severe than open-angle glaucoma, and causes approximately half of worldwide glaucoma blindness. In Spain the estimated prevalence of angle closure glaucoma is 0.4% of the adult population,<a class="elsevierStyleCrossRef" href="#bib0040">3</a> which means that primary angle-closure glaucoma is responsible of two of every 10 glaucomas. Unfortunately PACG continues to be largely underdiagnosed and missed by ophthalmologists.For many years, angle-closure glaucoma has been treated with laser peripheral iritodomy (PI). The EAGLE trial published in October 2016 found that clear lens extraction controls the intraocular pressure more effectively than laser PI, and patients are happier because their vision improves and most do not need to use glaucoma eye drops.<a class="elsevierStyleCrossRef" href="#bib0045">4</a> The economic evaluation showed that lens extraction also represents good value for money for the health service,<a class="elsevierStyleCrossRef" href="#bib0045">4</a> and after 10 years it is cost saving.The superiority of clear-lens extraction in terms of patient, clinical and economic outcomes, along with the low frequency of severe complications, as shown in the EAGLE trial, provides compelling evidence to support a change in current practice towards improved health outcomes for people with primary angle-closure glaucoma. Although the results are of particular relevance to low and middle-income countries where access to chronic medical therapy for the management of glaucoma is often not possible, they are also important for Spain. Of note, at 3 years 126 (60.6%) of participants in the clear-lens extraction group did not require any medication to control their condition and only one participant (0.5%) required glaucoma surgery. In contrast in the standard care group (laser iridotomy) only 45 (21.3%) participants did not require medications and 24 (11.3%) participants required further glaucoma surgery.The results of the EAGLE trial still require cautious interpretation and application to clinical practice. We recommend that clear lens extraction should be offered to those patients who fulfil the inclusion criteria in the trial as an option, but clinicians and patients should not interpret the trial as an obligation to undergo lens extraction surgery. Individualised discussion of the potential risks and benefits, with acknowledgement that laser PI with medications controls well the disease in most cases, and that the overall gain in quality of life is modest, should be important considerations. Lastly we should note that the results of the EAGLE trial may not be generalizable to patients who do not fulfil the inclusion/exclusion criteria of the trial and thus in such individuals clear lens extraction may not be justified." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Muñoz Negrete FJ, Azuara-Blanco A. Nuevo abordaje para el tratamiento del glaucoma por cierre angular primario tras el estudio EAGLE. Arch Soc Esp Oftalmol. 2017;92:351–352." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y.C. Tham" 1 => "X. Li" 2 => "T.Y. Wong" 3 => "H.A. Quigley" 4 => "T. Aung" 5 => "C.Y. Cheng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ophtha.2014.05.013" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology" "fecha" => "2014" "volumen" => "121" "paginaInicial" => "2081" "paginaFinal" => "2090" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24974815" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "WHO. Global data on visual impairments; 2014. <a href="http://www.who.int/mediacentre/factsheets/fs282/en/">http://www.who.int/mediacentre/factsheets/fs282/en/</a>." ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prevalence of primary angle closure glaucoma in European derived populations: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.C. Day" 1 => "G. Baio" 2 => "G. Gazzard" 3 => "C. Bunce" 4 => "A. Azuara-Blanco" 5 => "B. Munoz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bjophthalmol-2011-301189" "Revista" => array:6 [ "tituloSerie" => "Br J Ophthalmol" "fecha" => "2013" "volumen" => "96" "paginaInicial" => "1162" "paginaFinal" => "1167" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22653314" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "EAGLE study group" "etal" => true "autores" => array:6 [ 0 => "A. Azuara-Blanco" 1 => "J. Burr" 2 => "C. Ramsay" 3 => "D. Cooper" 4 => "P.J. Foster" 5 => "D.S. Friedman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(16)30956-4" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2016" "volumen" => "388" "paginaInicial" => "1389" "paginaFinal" => "1397" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27707497" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack291287" "titulo" => "Acknowledgments" "texto" => "Azuara-Blanco is the chief investigator of the EAGLE trial. The EAGLE trial was supported by the Medical Research Council (MRC G0701604) and funding is managed by the NIHR (EME 09-800-26) on behalf of the MRC-NIHR partnership. The views and opinions expressed in this article are those of the authors and do not necessarily reflect those of the funder of the study." 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ISSN: 2173-5794
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Archivos de la Sociedad Española de Oftalmología is the official journal of the Ophthalmology Society of Spain, that has over 4,000 members. It gives priority to the publication of basic, translational and clinic research including reviews, original articles, short communications, editorials, letters to the editor and clinic practice guides related to Ophthalmology and its subspecialties. A small section of the journal is reserved for the most relevant papers presented at the annual Congress of the Society. All manuscripts considered for publication are reviewed by expert examiner peers (double blind). The journal is published monthly and even though its official language is Spanish all articles are translated into English to increase the dissemination of scientific information. At present, Archivos is the only Spanish language Ophthalmology journal indexed in PubMed/MEDLINE in addition to other prestigious international databases such as Scopus.

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