Objective:

To compare the effect of medical treatment and trabeculectomy on intraocular pressure (IOP) peaks and fluctuations among patients with open-angle glaucoma, utilizing the water drinking test (WDT) as a reliable measure of IOP variability.

Key Findings:

• Trabeculectomy resulted in lower IOP peaks and fluctuations compared to medical therapy, with a statistically significant difference (p < 0.05).
• Significant differences in IOP fluctuation were observed, with surgically treated patients showing better stability (mean fluctuation: X mmHg vs. Y mmHg).
• A substantial number of medically treated patients exhibited higher IOP fluctuations despite achieving target pressures, indicating a need for closer monitoring.

Interpretation:

The findings suggest that trabeculectomy may provide superior control of IOP variability in glaucoma patients compared to medical therapy, highlighting the importance of surgical intervention in managing IOP fluctuations and potentially preventing disease progression.

Limitations:

• Small sample size may limit the generalizability of the findings; further studies with larger cohorts are recommended.
• Nonrandomized design could introduce selection bias, and future research should consider randomized controlled trials to validate these results.

Conclusion:

Trabeculectomy offers better IOP stability and lower fluctuations than medical therapy in managing open-angle glaucoma, emphasizing the need for surgical options in certain patient populations, particularly in settings with limited access to long-term medical therapy.