Arch Ophthalmol. 2000 Dec;118(12):1639-52. doi: 10.1001/archopht.118.12.1639.
To investigate the effect of cataract on visual function and the role of cataract in explaining a race-treatment interaction in outcomes of glaucoma surgery.
The Advanced Glaucoma Intervention Study (AGIS) enrolled 332 black patients (451 eyes) and 249 white patients (325 eyes) with advanced glaucoma. Eyes were randomly assigned to an argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy sequence or a trabeculectomy-ALT-trabeculectomy sequence. From the AGIS experience with cataract surgery during follow-up, we estimated the expected change in visual function scores from before cataract surgery to after cataract surgery. Then, for eyes with cataract not removed, we used these estimates of expected change to adjust visual function scores for the presumed effects of cataract. In turn, we used the adjusted scores to obtain cataract-adjusted main outcome measures.
Average percent of eyes with decrease of visual field (APDVF) and average percent of eyes with decrease of visual acuity (APDVA).
Within the 2 months before cataract surgery, visual acuity was better in eyes of white patients than of black patients by an average of approximately 2 lines on the visual acuity test chart. Cataract surgery improved visual acuity and visual field defect scores, with the amounts of improvement greater when preoperative visual acuity was lower. Adjustments for cataract brought about the following relative reductions: for APDVF, a relative reduction of 5% to 11% in black patients and 9% to 11% in white patients; for APDVA, a relative reduction of 45% to 49% in black patients and 31% to 38% in white patients; and for the APDVF and APDVA race-treatment interactions, relative reductions of 25% and 45%, respectively.
On average, visual function scores improved after cataract surgery. The findings of reduced race-treatment interactions after adjustment for cataract do not alter our earlier conclusion that the AGIS 7-year results support use of the ALT-trabeculectomy-trabeculectomy sequence for black patients and of the trabeculectomy-ALT-trabeculectomy sequence for white patients without life-threatening health problems. The choice of treatment should take into account individual patient characteristics and needs.
研究白内障对视觉功能的影响，以及白内障在解释青光眼手术结果中种族 - 治疗相互作用方面的作用。
高级青光眼干预研究（AGIS）纳入了332例患有晚期青光眼的黑人患者（451只眼）和249例白人患者（325只眼）。将眼睛随机分配至氩激光小梁成形术（ALT）-小梁切除术 - 小梁切除术序列或小梁切除术 - ALT - 小梁切除术序列。根据AGIS随访期间白内障手术的经验，我们估计了白内障手术前后视觉功能评分的预期变化。然后，对于未摘除白内障的眼睛，我们使用这些预期变化的估计值来调整视觉功能评分，以考虑白内障的假定影响。反过来，我们使用调整后的评分来获得经白内障调整的主要结局指标。
视野减小的眼睛的平均百分比（APDVF）和视力下降的眼睛的平均百分比（APDVA）。
在白内障手术前的2个月内，白人患者眼睛的视力在视力测试表上平均比黑人患者好约2行。白内障手术改善了视力和视野缺损评分，术前视力越低，改善程度越大。对白内障进行调整后带来了以下相对降低：对于APDVF，黑人患者相对降低5%至11%，白人患者相对降低9%至11%；对于APDVA，黑人患者相对降低45%至49%，白人患者相对降低31%至38%；对于APDVF和APDVA的种族 - 治疗相互作用，分别相对降低25%和45%。
平均而言，白内障手术后视觉功能评分有所改善。在对白内障进行调整后种族 - 治疗相互作用降低的结果并未改变我们先前的结论，即AGIS的7年结果支持对没有危及生命健康问题的黑人患者使用ALT - 小梁切除术 - 小梁切除术序列，对白人患者使用小梁切除术 - ALT - 小梁切除术序列。治疗选择应考虑个体患者的特征和需求。
