Visual field progression in the Collaborative Initial Glaucoma Treatment Study the impact of treatment and other baseline factors.
Visual field progression in the Collaborative Initial Glaucoma Treatment Study the impact of treatment and other baseline factors.
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DOI：
10.1016/j.ophtha.2008.08.051
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发表时间：
2009-02
期刊：
影响因子：
13.7
通讯作者：
CIGTS Study Investigators
中科院分区：
文献类型：
--
作者：
Musch DC;Gillespie BW;Lichter PR;Niziol LM;Janz NK;CIGTS Study Investigators
在青光眼初始治疗合作研究（CIGTS）中，使用治疗开始后9年的所有可用随访，评价与视野（VF）进展相关的因素。对随机临床试验参与者的纵向随访。607例新诊断青光眼患者。在一项随机临床试验中，607例新诊断的开角型青光眼患者最初接受药物治疗或小梁切除术治疗。在治疗开始和早期随访后，每隔6个月对受试者进行临床评价。CIGTS的两组研究参与者均接受积极治疗，以将眼内压（IOP）降低至或低于预定的眼睛特定目标压力。使用重复测量模型分析VF进展。VF进展，通过Humphrey 24-2全阈值测试测量，并通过平均偏差（MD）的变化进行评估，以及在每次随访访视时评估的VF实质性恶化的指标（MD较基线降低≥3 dB）。随访表明每个初始治疗组的平均MD较基线的变化极小。然而，在8年随访检查时，首次手术组和首次用药组中分别有21.3%和25.5%的MD较基线显著恶化（≥3 dB）。初始治疗对随后VF丧失的影响因时间（P<0.0001）、基线MD（P=0.03）和糖尿病（P=0.01）而改变。在基线时有晚期VF丧失的受试者中，初始手术导致的VF进展少于初始药物，而糖尿病受试者如果初始接受手术治疗，则随时间推移VF丧失更多。CIGTS干预方案导致两个治疗组的IOP随时间持续降低。在一个亚组中观察到VF丧失进展，增加至超过20%的受试者。我们关于初次手术对诊断为更晚期VF丧失的受试者有益，但对糖尿病患者有害的研究结果值得注意，并需要独立确认。
To evaluate factors associated with visual field (VF) progression, using all available follow-up through nine years after treatment initiation, in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Longitudinal follow-up of participants enrolled in a randomized clinical trial. 607 newly diagnosed glaucoma patients. In a randomized clinical trial, 607 subjects with newly diagnosed open-angle glaucoma were initially treated with either medication or trabeculectomy. After treatment initiation and early follow-up, subjects were evaluated clinically at 6-month intervals. Study participants in both arms of the CIGTS were treated aggressively in an effort to reduce intraocular pressure (IOP) to a level at or below a predetermined, eye-specific target pressure. VF progression was analyzed using repeated measures models. VF progression, measured by Humphrey 24-2 full threshold testing and assessed by the change in the mean deviation (MD), and an indicator of substantial worsening of the VF (MD decrease of ≥3 dB from baseline), assessed at each follow-up visit. Follow-up indicates minimal change from baseline in each initial treatment group’s average MD. However, at the eight year follow-up examination, substantial worsening (≥3 dB) of MD from baseline was found in 21.3% and 25.5% of the initial surgery and initial medicine groups, respectively. The effect of initial treatment on subsequent VF loss was modified by time (P<0.0001), baseline MD (P=0.03), and diabetes (P=0.01). Initial surgery led to less VF progression than initial medicine in subjects with advanced VF loss at baseline, whereas subjects with diabetes had more VF loss over time if treated initially with surgery. The CIGTS intervention protocol led to a lowering of IOP that persisted over time in both treatment groups. Progression in VF loss was seen in a subset increasing to over 20% of the subjects. Our findings regarding initial surgery being beneficial for subjects who present at diagnosis with more advanced VF loss, but detrimental for patients with diabetes, are noteworthy and warrant independent confirmation.
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