The Advanced Glaucoma Intervention Study (AGIS): 9. Comparison of glaucoma outcomes in black and white patients within treatment groups.
The Advanced Glaucoma Intervention Study (AGIS): 9. Comparison of glaucoma outcomes in black and white patients within treatment groups.
复制标题
高级青光眼干预研究 (AGIS)：9. 治疗组内黑人和白人患者青光眼结果的比较。
DOI：
10.1016/s0002-9394(01)01028-5
复制
发表时间：
2001
影响因子：
4.2
通讯作者：
AGISInvestigators
中科院分区：
文献类型：
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作者：
AGISInvestigators
目的比较黑人和白人患者在药物治疗失败后和开始手术干预后青光眼的进展情况。设计队列研究分析随机临床试验的数据。方法这项多中心研究包括药物治疗失败的开角型青光眼患者：332 名黑人患者的 451 只眼睛，249 名白人患者的 325 只眼睛。眼睛被随机分配至氩激光小梁成形术（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（TAT）序列；在数据库关闭时，他们已被追踪了 7 至 11 年。主要结局指标为视野下降（DVF）、视野持续下降（SDVF）、视力下降（DVA）、视力持续下降（SDVA）以及首次青光眼手术干预失败。统计方法包括逻辑回归以获得二元结果的平均调整后的黑人-白人比值比，以及Cox回归来估计调整后的黑人-白人风险比的事件发生时间结果。 结果在ATT序列中，黑人首次干预失败的风险低于白人（ALT，RR = 0.68，P = 0.040）。在 TAT 序列中，黑人首次干预失败（小梁切除术，RR = 1.79，P = 0.033）、眼压≥18 mm Hg（平均 OR = 1.41，P = 0.026）和 DVF（平均 OR = 1.78，P = 0.007）失败的风险高于白人。在这两种治疗序列中，黑人的平均处方药物数量多于白人（P≤0.002）。结论结果支持这样的假设：在药物治疗失败后和开始手术干预后，小梁切除术的初始干预比黑人患者更有效地延缓白人青光眼的进展。这些数据弱弱地表明，与白人患者相比，使用 ALT 进行初始手术干预可以更有效地延缓黑人青光眼的进展。
PURPOSETo compare in eyes of black and white patients the progression of glaucoma after failure of medical therapy and upon start of surgical intervention.DESIGNCohort study analysis of data from a randomized clinical trial.METHODSThis multicenter study included open-angle glaucoma patients who had failed medical therapy: 451 eyes of 332 black patients, 325 eyes of 249 white patients. Eyes were randomly assigned to an argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy (ATT) sequence or a trabeculectomy-ALT-trabeculectomy (TAT) sequence; they had been followed for 7 to 11 years at database closure. Main outcome measures were decrease of visual field (DVF), sustained decrease of visual field (SDVF), decrease of visual acuity (DVA), sustained decrease of visual acuity (SDVA), and failure of first surgical glaucoma intervention. Statistical methods included logistic regression to obtain average adjusted black-white odds ratios for binary outcomes, and Cox regression to estimate adjusted black-white risk ratios for time-to-event outcomes.RESULTSIn the ATT sequence blacks were at lower risk than whites of failure of first intervention (ALT, RR = 0.68, P = 0.040). In the TAT sequence blacks were at higher risk than whites of failure of the first intervention (trabeculectomy, RR = 1.79, P = 0.033), of intraocular pressure ≥18 mm Hg (average OR = 1.41, P = 0.026), and of DVF (average OR = 1.78, P = 0.007). In both treatment sequences, the average number of prescribed medications was greater for blacks than whites (P ≤ 0.002).CONCLUSIONSThe results support the hypothesis that after failure of medical therapy and upon initiation of surgical intervention, an initial intervention with trabeculectomy retards the progression of glaucoma more effectively in white than in black patients. The data provide a weak suggestion that an initial surgical intervention with ALT retards the progression of glaucoma more effectively in black than in white patients.