EARLY TRABECULECTOMY VERSUS CONVENTIONAL MANAGEMENT IN PRIMARY OPEN ANGLE GLAUCOMA
EARLY TRABECULECTOMY VERSUS CONVENTIONAL MANAGEMENT IN PRIMARY OPEN ANGLE GLAUCOMA
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DOI：
10.1136/bjo.72.12.881
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发表时间：
1988-12-01
影响因子：
4.1
通讯作者：
MURRAY, SB
中科院分区：
文献类型：
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作者：
JAY, JL;MURRAY, SB
一项治疗原发性开角型青光眼的随机、前瞻性、多中心试验的结果在长达五年的随访期内公布。选择两次眼压大于或等于26 mm Hg的未确诊病例，同时伴有青光眼的视野丧失特征。从99名患者中随机选择一只眼进行分析。对小梁切除术失败的患者进行常规内科治疗(A组)和确诊时小梁切除术(B组)进行比较，必要时辅以药物治疗。这些青光眼患者的预期寿命被发现与当地年龄和性别匹配的人口的预期寿命相似。在A组，4年后，由于药物治疗未能控制病情，53%的眼行了小梁切除术。眼压低于31 mm Hg且相对视野轻度丧失的患者(3年时为17%)低于眼压>30 mm Hg且有密集暗点的患者(3年时为75%)。与A组相比，早期手术提供了更稳定的控制，治疗变化较少。无论手术时间如何，小梁切除术后的平均眼压为15.0 mm Hg，显著低于第一年末那些被认为仅通过药物治疗控制的病例的眼压(20.8 mm Hg)。早期手术对视野有明显的保护作用，延迟手术可在术前出现额外的视野损失。视野的改变与Miotics的使用无关。两组的最终视力无显著差异，但A组有6例因进行性视野丧失而失去中心注视，B组无此病例。两组中约有10%的病例发生白内障，但A组的手术次数仅为B组的一半，且术后随访时间较B组短。在这种严重程度的原发性开角型青光眼中，延迟手术的风险明显大于以小梁切除术为主要治疗方法的患者。
The results of a randomised, prospective, multicentre trial of the management of primary open angle glaucoma are presented at up to five years'' follow up. Previously undiagnosed cases were selected with intraocular pressure of 26 mm Hg or more on two occasions together with field loss characteristic of glaucoma. Analysis was performed on one eye selected at random from each of 99 patients. Conventional medical treatment followed in unsuccessful cases by trabeculectomy (group A) was compared with trabeculectomy at diagnosis followed when necessary by supplementary medical therapy (group B). The life expectancy of these glaucoma patients was found to be similar to that for the local population matched for age and sex. In group A after four years trabeculectomy had been performed in 53% of eyes because medical management had failed to control the disease. The rate of operation was lower in those patients with intraocular pressure less than 31 mm Hg and mild relative field loss (17% at three years) than in those with intraocular pressure greater than 30 mm Hg and dense scotomas (75% at three years). Early surgery provided much more stable control with fewer changes in treatment than in group A. The group mean intraocular pressure after trabeculectomy was 15.0 mm Hg irrespective of the time of operation, and this was significantly lower than the intraocular pressure in those cases thought to be controlled on medical therapy alone at the end of the first year (20.8 mm Hg). Early operation provided significantly better protection of visual field, and the extra loss of visual field with delayed operation occurred in the preoperative period. Changes in visual fields were not related to the use of miotics. There was no significant difference in the final visual acuity in the two groups, but six cases in group A lost central fixation because of progressive loss of visual field, and there were no such cases in group B. Cataract occurred in approximately 10% of cases in both groups, but in group A this happened with only half the number of operations and at a shorter postoperative follow-up than in group B. It appears that in cases of primary open angle glaucoma of this severity the risk of delaying operation are significantly greater than those of performing trabeculectomy as the primary treatment.