The Advanced Glaucoma Intervention Study (AGIS): 11. Risk factors for failure of trabeculectomy and argon laser trabeculoplasty.
The Advanced Glaucoma Intervention Study (AGIS): 11. Risk factors for failure of trabeculectomy and argon laser trabeculoplasty.
复制标题
高级青光眼干预研究（AGIS）：11.小梁切除术和氩激光小梁成形术失败的危险因素。
DOI：
10.1016/s0002-9394(02)01658-6
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发表时间：
2002
影响因子：
4.2
通讯作者：
AGISInvestigators
中科院分区：
文献类型：
--
作者：
AGISInvestigators
目的探讨氩气激光小梁成形术（ALT）及小梁切除术失败与干预前后患者及眼部特征的关系。晚期青光眼干预研究参与者的设计队列研究。方法本研究于1988年至2001年间进行。1988 - 1992年间，591例35 - 80岁晚期青光眼患者789只眼随机分为两组手术治疗序列：氩激光小梁成形术(ALT)-小梁切除术-小梁切除术或小梁切除术-ALT-小梁切除术。在研究定义的每次干预失败（基于最大用药量、持续眼压（IOP）升高、视野缺损和椎间盘边缘恶化）后，患者接受后续干预。随访时间为8 - 13年。该报告基于对779只眼睛进行了至少3个月的随访。主要的结局指标是ALT和小梁切除术的失败，无论是作为第一次还是第二次干预。效应大小通过Cox多元回归分析得出的风险比（HR）及其相应的95%置信区间（CI）来衡量，其中HR对应于一个因素单位增加相关的风险变化系数。对于二元因素，这对应于有因素的眼睛的风险相对于没有因素的眼睛的风险的变化。结果与ALT失败相关的干预前因素为年龄较轻（HR = 0.98, CI = 0.96 ~ 0.99, P = 0.009）和IOP较高（1.11,1.08 ~ 1.15,P < 0.001）。干预前与小梁切除术失败相关的因素有：年龄较小（HR = 0.97, CI = 0.95-0.99, P = 0.005）、IOP较高（1.04,1.01-1.06,P = 0.002）、糖尿病（2.86,1.88-4.36,P < 0.001）及术后并发症（1.99,1.35-2.93,P < 0.001）。与小梁切除术失败风险增加显著相关的个别术后并发症是IOP升高（3.4,1.9-6.1,P < 0.001）和明显的炎症（2.4,1.3-4.6,P = 0.006）。结论：在本研究中，ALT失败与年龄更小、干预前IOP更高有关。小梁切除术失败与年龄较小、干预前IOP升高、糖尿病和一种或多种术后并发症相关，尤其是IOP升高和明显的炎症。
PURPOSETo investigate the association of pre-intervention and post-intervention patient and eye characteristics with failure of argon laser trabeculoplasty (ALT) and trabeculectomy.DESIGNCohort study of participants in the Advanced Glaucoma Intervention Study.METHODSThis multicenter study took place between 1988 and 2001. Between 1988 and 1992, 789 eyes of 591 patients aged 35 to 80 years with advanced glaucoma were randomized into one of two surgical treatment sequences: argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy or trabeculectomy-ALT-trabeculectomy. Upon study-defined failure (based on maximum medications, sustained intraocular pressure (IOP) elevation, visual field defect, and disk rim deterioration) of each intervention, patients were offered the subsequent intervention. Potential follow-up was 8 to 13 years. This report is based on data from 779 eyes that had at least 3 months of follow-up. The main outcome measures are failure of ALT and trabeculectomy, whether as first or second interventions. Effect size is measured by the hazard ratio (HR) and its corresponding 95% confidence interval (CI) obtained from Cox multiple regression analysis, where HR corresponds to the coefficient of change in risk associated with a unit increase in a factor. For binary factors, this corresponds to the change in risk in eyes with the factor relative to the risk in eyes without the factor.RESULTSPre-intervention factors associated with failure of ALT are younger age (HR = 0.98, CI = 0.96–0.99, P = .009) and higher IOP (1.11, 1.08–1.15, P < .001). Pre-intervention factors associated with failure of trabeculectomy are younger age (HR = 0.97, CI = 0.95–0.99, P = .005) and higher IOP (1.04, 1.01–1.06, P = .002), as well as diabetes (2.86, 1.88–4.36, P < .001) and any postoperative complication (1.99, 1.35–2.93, P < .001). Individual postoperative complications significantly associated with increased risk of failure of trabeculectomy are elevated IOP (3.4, 1.9–6.1, P < .001) and marked inflammation (2.4, 1.3–4.6, P = .006).CONCLUSIONSIn this study, ALT failure was associated with younger age and higher pre-intervention IOP. Trabeculectomy failure was associated with younger age, higher pre-intervention IOP, diabetes, and one or more postoperative complications, particularly elevated IOP and marked inflammation.