Risk of elevated intraocular pressure and glaucoma in patients with uveitis: results of the multicenter uveitis steroid treatment trial.
Risk of elevated intraocular pressure and glaucoma in patients with uveitis: results of the multicenter uveitis steroid treatment trial.
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DOI：
10.1016/j.ophtha.2013.01.025
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发表时间：
2013-08
期刊：
影响因子：
13.7
通讯作者：
MUST Research Group
中科院分区：
文献类型：
--
作者：
Friedman DS;Holbrook JT;Ansari H;Alexander J;Burke A;Reed SB;Katz J;Thorne JE;Lightman SL;Kempen JH;MUST Research Group
报告随机接受醋酸氟轻松（FA）植入剂或全身治疗的葡萄膜炎患者的2年内眼内压（IOP）升高和青光眼性视神经损伤的发生率。其次，探索与IOP升高或神经损伤相关的患者和眼睛特征。一项随机、部分设盲试验，患者随机接受FA植入或全身治疗。年龄≥ 13岁的患者在既往60天内患有非感染性中间、后葡萄膜炎或活动性全葡萄膜炎，适用于全身性皮质类固醇。在基线和每12个月使用Humphrey 24 - 2 SITA快速方案获得视野。在基线和3、6、12和24个月随访访视时拍摄立体视神经照片。每次研究访视时由设盲的检查者测量IOP。青光眼的诊断基于视神经杯盘比增加伴视野恶化或单纯杯盘比增加，当由于基线时数据缺失或严重视野丧失而无法评价视野变化的病例视野不可用时。大多数患者按分配接受治疗，在青光眼评价患者中，分别有97%和10%的患者接受植入物和全身治疗。更多的患者（65%）分配到植入物经历了至少10 mmHg的IOP升高，而24%分配到全身治疗（P <0.001）。同样，69%的植入组患者需要降眼压治疗，而全身组患者为26%（P <0.001）。青光眼性视神经损伤发生率分别为23%和6%（P <0.001）。除治疗分配外，黑人种族、使用降眼压药物和基线时葡萄膜炎活动与青光眼事件相关（P <0.05）。与分配接受全身治疗的患眼相比，分配接受植入物的患眼在前两年发生IOP升高≥ 10 mmHg和偶发性青光眼性视神经病变的风险约为4倍。中心视力未受影响。当威胁视力的炎症需要植入物治疗时，需要积极的IOP监测和早期治疗（通常包括早期滤过手术）以避免青光眼。
To report the two-year incidence of raised intraocular pressure (IOP) and glaucomatous optic nerve damage in patients with uveitis randomized to either fluocinolone acetonide (FA) implants or systemic therapy. Secondarily, to explore patient and eye characteristics associated with IOP elevation or nerve damage. A randomized, partially masked trial in which patients were randomized to either FA implants or systemic therapy. Patients age 13 years or older with non-infectious intermediate, posterior or panuveitis active within the prior 60 days for which systemic corticosteroids were indicated were eligible. Visual fields were obtained at baseline and every 12 months using the Humphrey 24-2 SITA-fast protocol. Stereoscopic optic nerve photos were taken at baseline and at 3, 6, 12 and 24-month follow-up visits. IOP was measured by masked examiners at every study visit. Glaucoma was diagnosed based on an increase in optic nerve cup-to-disc ratio with visual field worsening or increased cup-to-disc ratio alone, when visual fields were not available for cases where visual field change was not evaluable, due to missing data or severe visual field loss at baseline. Most patients were treated as assigned, among those evaluated for glaucoma 97% and 10% of patients assigned to implant and systemic treatment, respectively, received implants. More patients (65%) assigned to implants experienced an IOP elevation of at least 10 mmHg versus 24% assigned to systemic treatment (P<0.001). Similarly, 69% of patients assigned to the implant required IOP lowering therapy versus 26% in the systemic group (P<0.001). Glaucomatous optic nerve damage developed in 23% versus 6% (P<0.001) of implant and systemic patients, respectively. In addition to treatment assignment, black race, use of IOP-lowering medications and uveitis activity at baseline were associated with incident glaucoma (P < 0.05). Implant-assigned eyes had about a four-fold risk of developing IOP elevation ≥ 10 mmHg and of incident glaucomatous optic neuropathy over the first two years compared to those assigned to systemic therapy. Central visual acuity was unaffected. Aggressive IOP monitoring with early treatment (often including early filtration surgery) are needed to avoid glaucoma when vision-threatening inflammation requires implant therapy.
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影响因子：
--
作者：
Callanan, David G.;Jaffe, Glenn J.;Comstock, Timothy L.
通讯作者：
Comstock, Timothy L.
影响因子：
3.5
作者：
JENKINSON, C;WRIGHT, L;COULTER, A
通讯作者：
COULTER, A
影响因子：
2
作者：
Herbert, HM;Viswanathan, A;Lightman, SL
通讯作者：
Lightman, SL
黄斑水肿对中间，后膜炎和全膜炎的视觉功能的影响。
影响因子：
3.3
作者：
Taylor SR;Lightman SL;Sugar EA;Jaffe GJ;Freeman WR;Altaweel MM;Kozak I;Holbrook JT;Jabs DA;Kempen JH
通讯作者：
Kempen JH
影响因子：
--
作者：
Lowder, Careen;Belfort, Rubens, Jr.;Whitcup, Scott M.
通讯作者：
Whitcup, Scott M.