Purpose. To show a correlation between the evolution of the number of patients treated with a new glaucoma drug and the evolution of trabecular surgery between 1997 and 1999 in France

Methods. Number of ab externo trabeculectomies and trabeculotomies (procedures H428 and H416, used as tracking procedures for glaucoma surgery) were extracted from the national database of the French DRG system (covering both public and private hospitals). Number of patients treated per year has been estimated from drug unit sales (GERS marketing panel) and defined daily doses for each drug.

Results. Between 1997 and 1999, the number of trabeculectomies and trabeculotomies performed in France was reduced by 16% (from 19,233 to 16,133 interventions/year). Reduction was –28% in public hospitals and –9% in private clinics ; development of fistulizing or sclerotic surgery explains part of the reduction observed in private clinics, but not in public hospitals. During the same period, the number of patients treated with a new glaucoma drug increased from 476,000 to 760,000 equivalent patients/year. This increase is due to the launch of 3 new glaucoma drugs. Reduction of trabeculum surgeries is strongly correlated with the increase in the number of patients treated with latanoprost (r2=0.932), brimonidine (r2=0.996) and the fixed combination dorzolamide + timolol (r2=0.999).

Between 1997 and 1999, 73.1% of patients treated with a new drug have received latanoprost, 26.7% brimonidine and 0.2% the fixed combination dorzolamide + timolol.

Conclusions. In the absence of any other explanation, it is possible that part of trabecular surgery may have been substituted by new medical treatments (mostly latanoprost and brimonidine) providing better IOP control and delaying surgery for 16% of glaucoma patients between 1997 and 1999.