Natural history of normal-tension glaucoma.
Natural history of normal-tension glaucoma.
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DOI：
10.1016/s0161-6420(00)00518-2
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发表时间：
2001
期刊：
影响因子：
13.7
通讯作者：
W. L. Alward;F. Feldman;G. Trope;L. Cashwell;Jacob T. Wilensky;H. C. Geijssen;E. Greeve;H. Quigley;H. Jampel;J. Hopkins;G. Skuta;P. Lichter;P. Blondeau;Douglas R. Anderson;A. Grajewski;E. Hodapp;G. Balazsi;Marcel Amyot;D. Desjardins;R. Levene;D. Minckler;D. Heuer;S. Drance;F. Mikelberg;G. Douglas;M. Johnstone;John Hetherington;H. Hoskins;Irvin P. Pollack;D. Abrams;Richard P. Mills;O. Kasner;A. Schwartz;J. Liebmann;R. Ritch;John S. Cohen;A. Tuulonen;P. Airaksinen
中科院分区：
文献类型：
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作者：
W. L. Alward;F. Feldman;G. Trope;L. Cashwell;Jacob T. Wilensky;H. C. Geijssen;E. Greeve;H. Quigley;H. Jampel;J. Hopkins;G. Skuta;P. Lichter;P. Blondeau;Douglas R. Anderson;A. Grajewski;E. Hodapp;G. Balazsi;Marcel Amyot;D. Desjardins;R. Levene;D. Minckler;D. Heuer;S. Drance;F. Mikelberg;G. Douglas;M. Johnstone;John Hetherington;H. Hoskins;Irvin P. Pollack;D. Abrams;Richard P. Mills;O. Kasner;A. Schwartz;J. Liebmann;R. Ritch;John S. Cohen;A. Tuulonen;P. Airaksinen
目的：最近报道的一项随机研究描述了眼内压（IOP）在正常眼压性青光眼（NTG）发病机制中的作用以及治疗性降低IOP的效果。这是一份分析眼睛未接受治疗期间NTG自然病程的报告，无论是在等待随机化的时间间隔内，还是在随机分配不接受降低IOP治疗后。产品设计：分析前瞻性收集的一组未接受治疗的正常眼压性青光眼受试者长期病程的数据，这是一项随机对照临床试验的受试者子集。随机化和受试者选择：如果研究眼的视野缺损威胁到注视点，则受试者被随机分配立即开始治疗或在没有治疗的情况下观察，直至记录到进展。否则，仅当入组后显示视野进展、视盘杯状变进展或新发椎间盘出血时，才将患眼随机分配。参与者：本报告收集的数据来自于260例入组受试者中160例未接受治疗的受试者。其中49例受试者在入组时被随机分配为不接受治疗，24例受试者在一段时间内未接受治疗，随后被随机分配接受治疗，31例受试者接受类似的未接受治疗的随访，随后被随机分配接受额外一段时间的未接受治疗的随访，56例受试者入组但从未被随机分配。主要结果指标：本报告中仅使用了未指定眼睛接受治疗期间的视野数据，并通过两种进展指标进行分析：达到确认局部进展标准的“生存”时间和平均偏差（MD）指数随时间的变化率。研究结果：上述四个亚组在基线时相似，除了随访期间从未进展的56只眼睛的平均MD指数略好。通过对所有未接受治疗的受试者进行Kaplan-Meier分析，约三分之一在3年内显示局部进展，约一半在5 - 7年内显示局部进展。在随访3年或更长时间的受试者中，109名受试者中有62名没有显示MD随时间回归的统计学显著负斜率，而其他受试者显示MD下降的统计学显著性，主要在每年-0.2到-2分贝之间。结论：某些NTG病例进展比其他病例快。虽然大约一半的病例在7年内显示出确认的局部视野恶化，但这种变化通常较小且缓慢，通常不足以对MD指数产生可测量的影响。
OBJECTIVE: A recently reported randomized study described the role of intraocular pressure (IOP) in normal-tension glaucoma (NTG) pathogenesis and the effect of therapeutic lowering of IOP. This is a report of an analysis of the natural course of NTG during the time eyes were not receiving therapy, either in the time interval awaiting randomization or after being randomly assigned not to receive treatment to lower the IOP. DESIGN: Analysis of prospectively collected data on the long-term course of a cohort of untreated subjects with normal-tension glaucoma, a subset of subjects enrolled in a randomized controlled clinical trial. RANDOMIZATION AND SUBJECT SELECTION: If the field defect in the study eye threatened the point of fixation, the subject was randomly assigned to start on treatment immediately or to be observed without treatment until progression was documented. Otherwise, an eye was randomly assigned only when and if, subsequent to enrollment, it showed visual field progression, progression of optic disc cupping, or a new disc hemorrhage. PARTICIPANTS: Data were collected for this report on 160 subjects observed without treatment among a total enrollment of 260. They consist of 49 subjects who were randomly assigned on enrollment not to receive therapy, 24 followed without treatment for a time until later being randomly assigned to treatment, 31 similarly followed without treatment and who were later randomly assigned to be followed for an additional time without treatment, and 56 who enrolled but were never randomly assigned. MAIN OUTCOME MEASURES: Visual field data were used in this report only from the interval during which the eye had not been assigned to receive therapy and were analyzed by two measures of progression: the “survival” time to meeting a criterion of confirmed localized progression and the rate of change in the mean deviation (MD) index over time. RESULTS: The four subgroups just described were similar at baseline, except that the average MD index was slightly better for the 56 eyes that never progressed during the period of follow-up. By Kaplan-Meier analysis of all untreated subjects combined, approximately one third showed localized progression within 3 years and about half within 5 to 7 years. Of subjects followed for 3 years or more, 62 of 109 did not show a statistically significant negative slope of MD regressed over time, whereas the others showed a statistically significant MD decline, mainly between −0.2 and −2 db per year. CONCLUSIONS: Some cases of NTG progress more rapidly than others. Although approximately half of cases showed a confirmed localized visual field deterioration by 7 years, the change is typically small and slow, often insufficient to measurably affect the MD index.