In 15 patients with primary open-angle glaucoma who required surgery in both eyes because of progressive glaucomatous disease a peripheral iridectomy with thermal sclerostomy was performed in one eye and a trabeculectomy in the other eye, the choice of procedure being determined randomly. In all 15 cases at one year and 13 cases at 5 years after operation the immediate complication rate was higher in patients receiving peripheral iridectomy with thermal sclerostomy. The average final level of intraocular pressure (on no treatment) was 16 mmHg in patients receiving peripheral iridectomy with thermal sclerostomy and 22 mmHg in those in whom a trabeculectomy was performed. The control of disease was the same in both groups, there being an improvement in the visual field in approximately one-third of all cases and stability of the visual field in all other cases except for one. However, twice as many patients after trabeculectomy required additional medical therapy to maintain the intraocular pressure in a range that was considered satisfactory. Stability of intraocular pressure was virtually the same in both groups. The mechanism of control of intraocular pressure in patients receiving peripheral iridectomy with thermal sclerostomy appeared to be gross filtration in all cases, whereas such gross filtration was observed in only 2 eyes in which a trabeculectomy had been performed.
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