Intraocular pressure control and long-term visual field loss in the Collaborative Initial Glaucoma Treatment Study.
Intraocular pressure control and long-term visual field loss in the Collaborative Initial Glaucoma Treatment Study.
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DOI：
10.1016/j.ophtha.2011.01.047
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发表时间：
2011-09
期刊：
影响因子：
13.7
通讯作者：
CIGTS Study Group
中科院分区：
文献类型：
--
作者：
Musch DC;Gillespie BW;Niziol LM;Lichter PR;Varma R;CIGTS Study Group
评价开角型青光眼（OAG）长期治疗期间眼内压（IOP）控制措施对视野（VF）丧失进展的影响。纵向随机临床试验。607名新诊断的OAG参与者。研究参与者被随机分配到最初的药物治疗或小梁切除术，并在六个月的时间间隔进行检查。标准化测试包括Goldmann压平眼压计和Humphrey 24-2全阈值VF。随访期间IOP控制的汇总指标包括最大值、平均值、标准差（SD）、范围、小于16、18、20或22 mmHg的比例，以及所有IOP值是否均小于这四个临界点。VF结果的预测模型基于VF测试的平均偏差（MD），并根据年龄、性别、种族、基线VF丧失、治疗和时间进行调整。每个汇总IOP指标均作为累积的时间依赖性变量纳入，并在随机化后3 - 9年评估其与随后VF丧失的相关性。使用线性混合模型检测MD水平的变化，使用逻辑模型检测实质性恶化（3 dB或以上）的可能性升高。汉弗莱24-2全阈值VF测试的MD。在处理连续MD结局的模型中，药物组和手术组之间的汇总IOP测量结果的影响不同。校正基线风险因素后，在药物组中，三个IOP控制指标-最大IOP（p=0.0003），IOP标准差（p=0.0056）和IOP范围（p<0.0001）-的较大值与3 - 9年期间较低（更差）的MD显著相关。在手术组中，没有IOP汇总指标与随时间推移的MD显著相关。相同的三项IOP汇总指标也与MD的实质性恶化显著相关;然而，两个治疗组的效果相似。在预测IOP控制不充分的模型中，最大值、SD和IOP范围较高的一致显著预测因素包括黑人、较高的基线IOP和临床中心。这些结果支持在观察到IOP测量值过度升高或变化时考虑更积极的治疗。
To evaluate the impact of measures of intraocular pressure (IOP) control on progression of visual field (VF) loss during long-term treatment for open-angle glaucoma (OAG). Longitudinal, randomized clinical trial. 607 participants with newly-diagnosed OAG. Study participants were randomly assigned to initial treatment with medications or trabeculectomy, and underwent examination at six-month intervals. Standardized testing included Goldmann applanation tonometry and Humphrey 24-2 full threshold VFs. Summary measures of IOP control during follow-up included the maximum, mean, standard deviation (SD), range, proportion less than 16, 18, 20, or 22 mmHg, and whether all IOP values were less than each of these four cut-points. Predictive models for VF outcomes were based on the mean deviation (MD) from VF testing, and were adjusted for age, sex, race, baseline VF loss, treatment, and time. Each summary IOP measure was included as a cumulative, time-dependent variable, and its association with subsequent VF loss was assessed from 3 to 9 years post-randomization. Both linear mixed models, to detect shifts in MD levels, and logistic models, to detect elevated odds of substantial worsening (3 dB or more), were used. MD from Humphrey 24-2 full threshold VF tests. The effect of the summary IOP measures differed between the medicine and surgery groups in models that addressed the continuous MD outcome. After adjustment for baseline risk factors, in the medicine group larger values of three IOP control measures – maximum IOP (p=0.0003), standard deviation of IOP (p=0.0056), and range of IOP (p<0.0001) – were significantly associated with lower (worse) MD in the 3 to 9 year period. No IOP summary measure was significantly associated with MD over time in the surgery group. The same three IOP summary measures were also significantly associated with substantial worsening of MD; however, the effects were similar in both treatment groups. In models predicting inadequate IOP control, consistently significant predictors of higher maximum, SD, and range of IOP included black race, higher baseline IOP, and clinical center. These results support considering more aggressive treatment when undue elevation or variation in IOP measures is observed.
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影响因子：
13.7
作者：
Konstas, AGP;Topouzis, F;Stewart, WC
通讯作者：
Stewart, WC
影响因子：
13.7
作者：
Leske, M. Cristina;Heijl, Anders;Yang, Zhongming
通讯作者：
Yang, Zhongming
影响因子：
13.7
作者：
Kass, MA
通讯作者：
Kass, MA
影响因子：
13.7
作者：
Musch DC;Gillespie BW;Lichter PR;Niziol LM;Janz NK;CIGTS Study Investigators
通讯作者：
CIGTS Study Investigators
影响因子：
1.9
作者：
LAIRD, NM;WARE, JH
通讯作者：
WARE, JH