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Purpose  To study newly diagnosed glaucoma patients given mono‐ or multi‐therapy regarding differences in initial intraocular pressure ( IOP ) reduction, target  IOP  levels reached and influence of untreated baseline  IOP  on  IOP  reduction.    Methods  Patients newly diagnosed with manifest primary open‐angle glaucoma and included in the Glaucoma Intensive Treatment Study ( GITS ) were randomized to immediate intensive treatment with any of three different  IOP ‐lowering substances supplied in two bottles plus 360° laser trabeculoplasty or to conventional stepwise treatment starting with a single‐drug. Intraocular pressure reduction was analysed 1 month after initiation of treatment.    Results  One hundred eighteen patients (143 eyes) received mono‐therapy and 122 patients (152 eyes) multi‐therapy. Median baseline  IOP  was 24.0 (min: 9.7, max: 56.0) mmHg in mono‐therapy eyes and 24.0 (min: 12.3, max: 48.5) mmHg in multi‐therapy eyes (p = 0.56). After 1 month in the two groups, respectively, values for median  IOP  reduction were 6.3 (range: −5.3–31.0) and 11.0 (range: 0.7–34.5) mmHg, and for mean relative decline 26.8 (range: −32.0–55.4) and 46.0 (range: 4.6–81.6) % (p = 0.000). A larger proportion of the multi‐therapy patients reached each target  IOP  level (p = 0.000). The higher the baseline  IOP , the larger the observed pressure reduction, considering both absolute and relative figures. The effect was more pronounced in eyes with multi‐therapy than in those with mono‐therapy (p = 0.000). For every mmHg higher  IOP  at baseline, the  IOP  was reduced by an additional 0.56 (mono‐therapy) or 0.84 (multi‐therapy) mmHg.    Conclusion  Intensive treatment led to considerably greater  IOP  reduction than mono‐therapy. Among patients with  IOP  ≥30 mmHg at diagnosis an  IOP  of <16 was reached in 2/3 of those with multi‐therapy but in none with mono‐therapy. The  IOP  reduction was highly dependent on the untreated  IOP  level.

acta ophthalmologica

Initial intraocular pressure reduction by mono‐ versus multi‐therapy in patients with open‐angle glaucoma: results from the Glaucoma Intensive Treatment Study