高级青光眼干预研究：8.小梁切除术后白内障形成的风险。

The Advanced Glaucoma Intervention Study: 8. Risk of cataract formation after trabeculectomy.

出版信息

Arch Ophthalmol. 2001 Dec;119(12):1771-9. doi: 10.1001/archopht.119.12.1771.

DOI:10.1001/archopht.119.12.1771

Abstract

OBJECTIVES

To compare the risk of cataract formation in eyes with and without prior trabeculectomy and to assess other risk factors for cataract.

METHODS

The Advanced Glaucoma Intervention Study (AGIS) has been following 789 eyes in 591 patients with medically uncontrolled open-angle glaucoma. From 1988 to 1992, these eyes were randomly assigned to either an argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy treatment sequence or a trabeculectomy-ALT-trabeculectomy sequence. Cox regression analyses were used to assess risk factors for cataract formation during 7 to 11 years of follow-up.

MAIN OUTCOME MEASURES

Cataract, defined as either having had cataract surgery or confirmed severe lens opacity with a best-corrected Early Treatment Diabetic Retinopathy Study visual acuity score less than 65 letters (worse than 20/50).

RESULTS

Data are presented on the expected 5-year cumulative probability of cataract formation in each randomized sequence by age and presence of diabetes at study entry. Overall, approximately half of the eyes studied developed cataract. A first trabeculectomy, whether as the first or second AGIS intervention, increased the overall risk of cataract by 78% (risk ratio [RR] = 1.78; P<.001). Diabetes (RR = 1.47; P =.004) and age at study entry (RR = 1.07 per year of age; P<.001) were also risk factors for cataract. When postoperative complications of trabeculectomy were included in the analysis, the increased risk of cataract for eyes with a first trabeculectomy reduced to 47% when complications did not occur (RR = 1.47; P =.003) and increased to 104% when complications did occur (RR = 2.04; P<.001). Several specific postoperative complications of trabeculectomy were associated with increased risk of cataract, particularly marked inflammation (RR = 3.29; P<.001) and flat anterior chamber (RR = 1.80; P =.004). Trabeculectomy with complications was also significantly associated with an increased risk of cataract in each of 3 lens regions: nuclear, cortical, and posterior subcapsular.

CONCLUSIONS

In eyes of AGIS patients, after adjustment for age and diabetes, trabeculectomy increased the risk of cataract formation by 78%.

摘要

目的

比较曾接受小梁切除术和未接受过小梁切除术的眼睛发生白内障的风险，并评估白内障的其他风险因素。

方法

青光眼高级干预研究（AGIS）一直在追踪591例药物治疗无法控制的开角型青光眼患者的789只眼睛。从1988年到1992年，这些眼睛被随机分配到氩激光小梁成形术（ALT）-小梁切除术-小梁切除术治疗序列或小梁切除术-ALT-小梁切除术序列。采用Cox回归分析评估随访7至11年期间白内障形成的风险因素。

主要观察指标

白内障，定义为接受过白内障手术或经确认存在严重晶状体混浊且最佳矫正早期糖尿病性视网膜病变研究视力评分低于65个字母（视力差于20/50）。

结果

按年龄和研究入组时是否患有糖尿病，列出了每个随机序列中预期的5年白内障形成累积概率数据。总体而言，约一半接受研究的眼睛发生了白内障。首次小梁切除术，无论作为AGIS的首次还是第二次干预，都会使白内障的总体风险增加78%（风险比[RR]=1.78；P<0.001）。糖尿病（RR=1.47；P=0.004）和研究入组时的年龄（每年年龄RR=1.07；P<0.001）也是白内障的风险因素。当将小梁切除术的术后并发症纳入分析时，首次小梁切除术的眼睛发生白内障的风险增加，若未发生并发症则降至47%（RR=1.47；P=0.003），若发生并发症则增至104%（RR=2.04；P<0.001）。小梁切除术的几种特定术后并发症与白内障风险增加相关，尤其是明显的炎症（RR=3.29；P<0.001）和无前房（RR=1.80；P=0.004）。伴有并发症的小梁切除术在晶状体的3个区域（核、皮质和后囊下）中的每一个区域也都与白内障风险增加显著相关。