The Advanced Glaucoma Intervention Study (AGIS): 5. Encapsulated bleb after initial trabeculectomy.
The Advanced Glaucoma Intervention Study (AGIS): 5. Encapsulated bleb after initial trabeculectomy.
复制标题
高级青光眼干预研究 (AGIS)：5. 初次小梁切除术后出现包囊泡。
DOI：
10.1016/s0002-9394(98)00290-6
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发表时间：
1999
影响因子：
4.2
通讯作者：
Cyrlin,MN
中科院分区：
文献类型：
--
作者：
Schwartz,AL;VanVeldhuisen,PC;Gaasterland,DE;Ederer,F;Sullivan,EK;Cyrlin,MN
目的比较有无小梁成形术和有无小梁成形术的眼的小梁切除术后囊性滤过泡的发生率，并评估形成囊性滤过泡的其他危险因素。方法：在药物治疗失败后，纳入晚期青光眼干预研究(AGIS)的眼睛被随机分配到开始于Ar激光小梁成形术或小梁切除术的干预序列中。本文比较了119眼小梁激光成形术失败患者和379眼未行激光小梁成形术患者小梁切除术后1年的临床病程。在诊断囊性滤过泡时、3个月和6个月后收集有关滤过泡包裹的数据。结果在AGIS数据中对发生包裹性滤过泡的风险的多因素进行了检验，只有男性性别和高中毕业后未接受进一步正规教育有统计学意义。有Ar激光小梁成形术失败者18.5%，无Ar激光小梁成形术史者14.5%(未调整相对危险度1.27；95%可信区间=0.81，2.00；P=0.23)。在调整了年龄、性别、教育程度、开出的全身性β阻滞剂、糖尿病、视野评分和青光眼诊断年限后，这种差异在统计学上仍然没有显著意义。小梁切除术后4周，眼内压(22.5 mm Hg)高于无滤过泡(15.0 mm Hg)的平均眼压7.5 mm Hg；在小梁切除术后1年，根据需要恢复药物治疗，眼压超标降至1.4 mm Hg。包括本研究在内的四项研究报告了以前接受过Ar激光小梁成形术的眼球包裹率较高；在其中两项研究中，其中一项是目前的研究，其包裹率在统计学上没有显著提高；在另外两项研究中，包裹率显著更高。术后4周平均眼压高于无滤过泡，随着药物治疗的恢复，两种方法在1年后趋于一致。
PURPOSETo compare the incidence of encapsulated bleb after trabeculectomy in eyes with and without previous argon laser trabeculoplasty and to assess other risk factors for encapsulated bleb development.METHODSAfter medical treatment failure, eyes enrolled in the Advanced Glaucoma Intervention Study (AGIS) were randomly assigned to sequences of interventions starting with either argon laser trabeculoplasty or trabeculectomy. In the present study we compared the clinical course for 1 year after trabeculectomy in 119 eyes with failed argon laser trabeculoplasty with that of 379 eyes without previous argon laser trabeculoplasty. Data on bleb encapsulation were collected at the time that the encapsulation was diagnosed, and 3 and 6 months later.RESULTSOf multiple factors examined in the AGIS data for the risk of developing encapsulated bleb, only male gender and high school graduation without further formal education were statistically significant. Encapsulation occurred in 18.5% of eyes with previous argon laser trabeculoplasty failure and 14.5% of eyes without previous argon laser trabeculoplasty (unadjusted relative risk, 1.27; 95% confidence limits = 0.81, 2.00; P = .23). After adjusting for age, gender, educational achievement, prescribed systemic β-blockers, diabetes, visual field score, and years since glaucoma diagnosis, this difference remains statistically not significant. Four weeks after trabeculectomy, mean intraocular pressure was 7.5 mm Hg higher in eyes with (22.5 mm Hg) than without (15.0 mm Hg) encapsulated bleb; at 1 year after trabeculectomy and the resumption of medical therapy when needed, this excess was reduced to 1.4 mm Hg.CONCLUSIONSThis study, as did two previous studies, found male gender to be a risk factor for bleb encapsulation. Four studies, including the present study, have reported a higher rate of encapsulation in eyes with previous argon laser trabeculoplasty; in two of the studies, one of which was the present study, the rate was not statistically significantly higher; in the other two studies the rate was significantly higher. The 4-week postoperative mean intraocular pressure was higher in eyes with than without encapsulated bleb; with the resumption of medical treatment the two means converged after 1 year.