COLLABORATIVE STUDY OF INITIAL GLAUCOMA TREATMENT

美国在管理患者方面的传统智慧 新诊断的开角型青光眼是建立局部医学 心理治疗。根据需要增加医疗方案，以实现 眼压降低被认为足以阻止 视神经和视野损害的进展。如果医疗队 方案不充分，经常尝试激光小梁成形术，如果 有一种合理的预期是，足够的压力降低 可能会实现。如果这样的期望不现实和/或 尝试了氩激光小梁成形术，但未能控制眼内 采用加压、切口式滤过手术。 最近的研究，特别是在英国，表明最初的 开角型青光眼的治疗最好是滤过 手术，这种方法的原理是基于更好的 视功能参数的结果。拟议的临床试验 将新诊断为开角型青光眼的患者随机分为 要么是药物治疗，要么是外科手术。评估将是 由视觉功能、眼压和生活质量构成 由患者在内科和外科治疗方案上实现。空值 需要检验的假设包括，在两种情况下， 在保护视觉功能方面有两种治疗方式， 达到的眼压水平和总体生活满意度 经验丰富。这项临床试验将在11点进行。 中心，并将包括社区眼科医生的参与 不仅要协助招募和管理病人， 而是为了提高试验结果的概括性。

Conventional wisdom in the United States in managing patients with newly-diagnosed open angle glaucoma is to institute topical medical therapy. The medical regimen is increased as necessary to achieve an intraocular pressure reduction considered sufficient to preclude progression of optic nerve and visual field damage. If the medical regimen is inadequate, argon laser trabeculoplasty is often tried if there is a reasonable expectation that adequate pressure reduction might be achieved. If such an expectation is not realistic and/or if argon laser trabeculoplasty is tried and fails to control intraocular pressure, incisional filtration surgery is utilized. Recent studies, particularly in Great Britain, suggest that initial treatment for open angle glaucoma is best handled with filtration surgery and that the rationale for such an approach is based on better outcomes of visual function parameters. The proposed clinical trial will randomize patients with newly-diagnosed open angle glaucoma to either a medical regimen or a surgical approach. Assessments will be made of visual function, intraocular pressure, and the quality of life achieved by patients on the medical and surgical regimens. Null hypotheses to be tested include the lack of a difference between the two treatment modalities in terms of preservation of visual function, level of intraocular pressure achieved, and overall life satisfaction experienced. This clinical trial will take place at 11 Clinical Centers and will include the participation of community ophthalmologists to not only assist in recruitment and management of patients, but to improve the generalizability of the trial's results.