Edmunds Beth, Bunce Catey V, Thompson John R, Salmon John F, Wormald Richard P
Royal College of Ophthalmologists, London, United Kingdom.
Ophthalmology. 2004 Jan;111(1):97-103. doi: 10.1016/j.ophtha.2003.04.005.
To examine the relationships between study factors and trabeculectomy outcome in a representative sample of United Kingdom ophthalmology surgeons and patients.
Cross-sectional observational study by questionnaire.
All ophthalmic surgeons performing trabeculectomy in the National Health Service were invited to select their 4 most recent consecutive trabeculectomy cases satisfying study eligibility criteria before June 1996. Three hundred eighty-two surgeons supplied baseline data for 1450 patients and 1-year follow-up data for 1240 (85.3%) patients. All patients had undergone first-time trabeculectomy for chronic open-angle glaucoma.
Data were collected by self-administered questionnaires at baseline and 6 and 12 months postoperatively. Univariate analysis of the relationships between study factors and success was performed by chi-square test (categorical variables) and Student's t or Mann-Whitney U tests (continuous variables). Multiple logistic regression modeling of explanatory variables significant at a P value of </=0.1 was then performed.
Trabeculectomy success, defined as a final intraocular pressure (IOP) less than two thirds of the preoperative IOP, excluding patients on antiglaucoma medications.
After multiple logistic regression modeling, diabetes (odds ratio [OR] = 0.485, 95% confidence interval [CI] = 0.271-0.868, P = 0.015), superior rectus traction suture (OR = 0.580, 95% CI = 0.348-0.959, P = 0.034), subconjunctival anesthetic (OR = 0.172, 95% CI = 0.065-0.459, P<0.0001), and nonspecialist surgeons (OR = 0.539, 95% CI = 0.335-0.865, P = 0.010) remained significantly associated with poorer outcome.
In this nationally representative sample of glaucoma patients undergoing first-time trabeculectomy, we have identified important associations between diabetes, superior rectus traction suture, subconjunctival anesthetic, nonspecialist surgeons, and diminished trabeculectomy success. These associations merit further examination.
在英国眼科外科医生和患者的代表性样本中，研究相关因素与小梁切除术结果之间的关系。
通过问卷调查进行横断面观察性研究。
邀请所有在国民医疗服务体系中进行小梁切除术的眼科外科医生，挑选出他们在1996年6月之前最近连续的4例符合研究入选标准的小梁切除术病例。382名外科医生提供了1450例患者的基线数据以及1240例（85.3%）患者的1年随访数据。所有患者均因慢性开角型青光眼接受首次小梁切除术。
在基线、术后6个月和12个月通过自填式问卷收集数据。通过卡方检验（分类变量）以及学生t检验或曼-惠特尼U检验（连续变量）对研究因素与手术成功之间的关系进行单因素分析。然后对P值≤0.1时具有显著意义的解释变量进行多因素逻辑回归建模。
小梁切除术成功定义为最终眼压低于术前眼压的三分之二，不包括使用抗青光眼药物的患者。
经过多因素逻辑回归建模后，糖尿病（比值比[OR]=0.485，95%置信区间[CI]=0.271 - 0.868，P = 0.015）、上直肌牵引缝线（OR = 0.580，95%CI = 0.348 - 0.959，P = 0.034）、结膜下麻醉（OR = 0.172，95%CI = 0.065 - 0.459，P<0.0001）以及非专科外科医生（OR = 0.539，95%CI = 0.335 - 0.865，P = 0.010）仍与较差的手术结果显著相关。
在这个全国代表性的首次接受小梁切除术的青光眼患者样本中，我们确定了糖尿病、上直肌牵引缝线、结膜下麻醉、非专科外科医生与小梁切除术成功率降低之间的重要关联。这些关联值得进一步研究。
