Advances in the treatment of glaucoma: comparison between clinical and surgical interventions in preserving visual acuity

Abstract

Glaucoma is one of the main causes of irreversible blindness in the world, affecting millions of people globally. Clinical and surgical interventions aim to reduce intraocular pressure (IOP), a key risk factor for the progression of the disease. Recent advances include new drugs, minimally invasive techniques (MIGS) and traditional surgical procedures, all with different impacts on preserving visual acuity. This study was conducted by means of an integrative literature review, using articles published between 2012 and 2024, collected from the PubMed, Cochrane and Scopus databases. We included randomized clinical trials, systematic reviews and meta-analyses that evaluated the effectiveness of clinical and surgical interventions in the treatment of glaucoma, with a focus on preserving visual acuity. The selection of articles followed the PRISMA criteria, resulting in a final sample of 30 studies addressing both clinical and surgical treatments. Clinical interventions, such as the use of hypotensive eye drops, have shown efficacy in reducing IOP by up to 30%, but with challenges related to long-term adherence to treatment. Surgical studies have shown that trabeculectomy and drainage devices are effective in sustainably reducing IOP (35%-45%) and preserving visual acuity.  MIGS and laser procedures, such as selective trabeculoplasty, present a lower risk of post-operative complications, although their long-term efficacy is still under investigation.Surgical interventions demonstrate greater efficacy in preserving visual acuity in patients with advanced glaucoma, while clinical approaches are suitable for early stages of the disease. Minimally invasive techniques offer promising alternatives with lower risks, but require more long-term studies for full evaluation. The choice of treatment should be personalized based on the patient's characteristics and the stage of glaucoma.