The Advanced Glaucoma Intervention Study (AGIS): 4. Comparison of treatment outcomes within race. Seven-year results.
The Advanced Glaucoma Intervention Study (AGIS): 4. Comparison of treatment outcomes within race. Seven-year results.
复制标题
高级青光眼干预研究 (AGIS)：4. 种族内治疗结果的比较。
DOI：
10.1016/s0161-6420(98)97013-0
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发表时间：
1998
期刊：
影响因子：
13.7
通讯作者：
中科院分区：
文献类型：
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作者：
本报告的目的是分别为黑人和白色晚期青光眼患者提供两种替代手术干预序列的7年结果。参与者：共有332名黑人患者（451只眼），249名白色患者（325只眼）和10名其他种族患者（13只眼）参与。潜在的随访时间为4 - 7年。干预眼睛被随机分配到氩激光小梁成形术（ALT）-小梁切除术-小梁切除术（ATT）序列或小梁切除术-ALT-小梁切除术（达特）序列。主要观察指标：视野下降眼的百分率（APDVF）、视力下降眼的平均百分率（APDVA）和视力下降眼的平均百分率（APDV）。视野降低（DVF）是指青光眼视野缺损量表（0 - 20）较基线增加至少4分，视敏度降低（DVA）是指较基线降低至少15个字母（3行），视力降低（DV）是指发生DVF或DVA。平均值是从第一次6个月访视到指定观察期结束的6个月间隔观察到的降低百分比。在整个7年随访中，在黑人和白色患者中，达特组眼的眼内压平均降低更大，ATT组眼的首次干预失败的累积概率更大。在黑人患者中，7年内ATT序列的APDVF、APDVA和APDV均低于达特序列。在白色患者中，APDVF也支持ATT序列，但仅在第一年，之后支持达特序列直到第七年; APDVA也支持ATT序列，但ATT-TAT差异在7年内逐渐减小;而APDV最初更倾向于达特，但4年后，结论这些数据支持所有黑人患者使用ATT序列。对于没有危及生命的健康问题的白色患者，数据支持使用达特序列。
OBJECTIVEThe purpose of this report is to present separately for black and white patients with advanced glaucoma 7-year results of two alternative surgical intervention sequences.DESIGNA randomized controlled trial.PARTICIPANTSA total of 332 black patients (451 eyes), 249 white patients (325 eyes), and 10 patients of other races (13 eyes) participated. Potential follow-up ranged from 4 to 7 years.INTERVENTIONEyes were randomly assigned to either an argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy (ATT) sequence or a trabeculectomy-ALT-trabeculectomy (TAT) sequence. The second and third interventions were offered after failure of the first and second interventions, respectively.MAIN OUTCOME MEASURESAverage percent of eyes with decrease of visual field (APDVF), average percent of eyes with decrease of visual acuity (APDVA), and average percent of eyes with decrease of vision (APDV) are the outcome measures. Decrease of visual field (DVF) is an increase from baseline of at least 4 points on a glaucoma visual field defect scale ranging from 0 to 20, decrease of visual acuity (DVA) is a decrease from baseline of at least 15 letters (3 lines), and decrease of vision (DV) is the occurrence of either DVF or DVA. The averages are of percent decreases observed at 6-month intervals from the first 6-month visit to the end of the specified observation period.RESULTSIn both black and white patients throughout 7-year follow-up, the mean decrease in intraocular pressure was greater in eyes assigned to TAT, and the cumulative probability of failure of the first intervention was greater in eyes assigned to ATT. In black patients, APDVF, APDVA, and APDV are less for the ATT sequence than for the TAT sequence throughout the 7 years. In white patients, APDVF also favors the ATT sequence but only for the first year, after which it favors the TAT sequence through the seventh year; APDVA also favors the ATT sequence, but the ATT-TAT difference progressively diminishes over 7 years; and APDV favors ATT over TAT initially, but after 4 years, the advantage switches to and remains with TAT.CONCLUSIONSThese data support use of the ATT sequence for all black patients. For white patients without life-threatening health problems, the data support use of the TAT sequence.