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The Case for Initial Surgery: Results From the Collaborative Initial Glaucoma Treatment Study (CIGTS)-专题讲座 |
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| The Case for Initial Surgery: Results From the Collaborative Initial Glaucoma Treatment Study (CIGTS)-专题讲座 |
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作者：Paul R. … 文章来源：W.K. Kellogg Eye Center,University of Michigan,USA 点击数：1509 更新时间：2006/7/6 19:33:17 
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| The Collaborative Initial Glaucoma Treatment Study was originally conceived to evaluate, in newly diagnosed patients with open-angle glaucoma, whether the preferred initial treatment is with medications or with trabeculectomy. Visual field (VF) loss was the primary outcome variable. There were 14 clinical centers and 607 patients were enrolled. Three hundred patients underwent initial trabeculectomy and 307 patients were treated initially with medication.
Collective data from randomized, controlled clinical trials in glaucoma have shown that visual field loss is greatly reduced by a marked reduction in intraocular pressure (IOP) from baseline by at least forty percent. In fact, in the CIGTS, relatively little VF loss occurred when IOP was reduced to such an extent. In our report of the interim data—following five years of follow-up—there was no significant difference in VF loss between the medically and surgically treated groups. However, we have recently analyzed our data to determine whether the extent of VF loss at baseline might make a difference in whether or not the initial treatment approach matters in terms of ultimate VF loss.
We found that patients with a minor amount of VF loss at baseline (mean deviation of -2 dB or better field) had similar VF results whether treated initially with medications or with surgery. However, in those patients with more extensive VF loss at baseline (mean deviation of -10 dB or worse) initial treatment with trabeculectomy resulted in significantly less VF loss over time than did initial treatment with medications.
The reason for this finding may be that initial treatment with trabeculectomy results in less longitudinal variability in IOP than does initial treatment with medications. We found that our patient cohort showed greater VF loss when there was greater IOP fluctuation over time.
In summary, clinicians should consider initial treatment with trabeculectomy in newly diagnosed open-angle glaucoma patients who present with substantial visual field loss.
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