Different patterns of glaucoma management in South Punjab.

Objectives: Glaucoma is the most common blinding condition in South Punjab of Pakistan and its management is a challenge due to illiteracy and lack of financial resources. Study Design: Randomized Clinical Trial. Setting: Department of Ophthalmology Nishtar Hospital Multan. Period: June 2016 - June 2018. Material & Methods: We have randomly selected patients on the basis of Cup to Disc ratio and applied randomized clinical trial of both medical and surgical modalities of glaucoma management to observe the visual outcomes in terms of Intraocular pressure and Cup to disc ratio. We have also linked the effects of our management with lenticular status of the patients which has shown significant results. Results: The vision survival of trabeculectomy in pseudophakics was 88.77% while only 9.8% was the survival rate of trabeculectomy in phakics. 90% of 31 phakic patients who underwent trabeculectomy failed. Similarly patients on 3 IOP lowering drugs had 70% vision survival rate out of 260 patients treated. Patients with C-D ratio 0.8 had maximum failure rate of 69% out of 78 patients in which medical treatment failed. Conclusion: Trabeculectomy significantly reduced the intraocular pressure in patients in which pharmacological treatment failed.The success rate of trabeculectomy among pseudophakics is high. In Phakics, when only Trabeculectomy is done, success rate is low. When trabeculectomy and clear lens extraction is done simultaneously, the success rate is slightly higher. When trabeculectomy is done after clear lens extraction, the success rate is highest. In case of Cataract, cataract extraction and trabeculectomy when done simultaneously, show low success rate. When trabeculectomy was done after cataract extraction, shows highest success rate.