COLLABORATIVE STUDY OF INITIAL GLAUCOMA TREATMENT

在美国，传统的管理病人的智慧， 新诊断的开角型青光眼是建立局部医疗 疗法 必要时增加医疗方案，以实现 眼内压降低被认为足以排除 视神经和视野损害的进展。 如果医疗 如果治疗方案不充分，则通常尝试氩激光小梁成形术， 有合理的预期， 可能实现。 如果这样的期望不现实和/或如果 尝试氩激光小梁成形术，但未能控制眼内 使用压力、切口滤过手术。 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采用滤过法 手术，这种方法的基本原理是基于更好的 视觉功能参数的结果。 拟定临床试验 将对新诊断的开角型青光眼患者进行随机分组， 无论是药物治疗还是手术治疗 评估将 由视觉功能、眼内压和生活质量组成 通过内科和外科治疗方案实现的。 Null 需要检验的假设包括： 两种治疗方式在视觉功能的保护方面， 达到的眼内压水平和总体生活满意度 经验丰富。 这项临床试验将在11临床 中心，并将包括社区眼科医生的参与 不仅帮助招募和管理病人， 而是为了提高试验结果的普遍性。

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.