Leske M Cristina, Heijl Anders, Hyman Leslie, Bengtsson Boel, Dong LiMing, Yang Zhongming
Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York 11794-8036, USA.
Ophthalmology. 2007 Nov;114(11):1965-72. doi: 10.1016/j.ophtha.2007.03.016. Epub 2007 Jul 12.
To determine progression factors at the end of the Early Manifest Glaucoma Trial (EMGT) based on all EMGT patients and evaluate separately patients with higher and lower baseline intraocular pressure (IOP; median split).
Cohort of clinical trial participants.
Patients with early open-angle glaucoma randomized to argon laser trabeculoplasty plus betaxolol (n = 129) or no immediate treatment (n = 126), examined every 3 months for up to 11 years.
Cox proportional hazard analyses, expressed by hazard ratios (HRs) and 95% confidence intervals (CIs).
Time to progression, defined by perimetric and photographic disc criteria.
Overall progression was 67% when follow-up ended (median, 8 years). Treatment approximately halved progression risk (HR, 0.53; 95% CI, 0.39-0.72); results were similar for patients with higher and lower baseline IOP (HRs, 0.41 and 0.55). Baseline progression factors (HRs, 1.51-2.12; P<0.01) were higher IOP, exfoliation, bilateral disease, and older age, as previously reported. New baseline predictors were lower ocular systolic perfusion pressure in all patients (< or =160 mmHg; HR, 1.42; 95% CI, 1.04-1.94), cardiovascular disease history (HR, 2.75; 95% CI, 1.44-5.26) in patients with higher baseline IOP, and lower systolic blood pressure (BP) (< or =125 mmHg; HR, 0.46; 95% CI, 0.21-1.02) in patients with lower baseline IOP. Postbaseline progression factors were IOP levels at follow-up, with 12% to 13% average increase per millimeter of mercury in all patients (HRs, 1.12-1.13 per mmHg higher) and similar results in patients with higher and lower baseline IOP (HRs, 1.15 and 1.13 per mmHg higher). Disc hemorrhages (HR, 1.02; 95% CI, 1.01-1.03 per percent higher frequency) also predicted progression. Thinner central corneal thickness (CCT) (HR, 1.25; 95% CI, 1.01-1.55 per 40 microm lower) was a new significant factor, a result observed in patients with higher baseline IOP (HR, 1.42; 95% CI, 1.05-1.92 per 40 microm lower) but not lower baseline IOP, with significant IOP-CCT interaction.
Treatment and follow-up IOP continued to have a marked influence on progression, regardless of baseline IOP. Other significant factors were age, bilaterality, exfoliation, and disc hemorrhages, as previously determined. Lower systolic perfusion pressure, lower systolic BP, and cardiovascular disease history emerged as new predictors, suggesting a vascular role in glaucoma progression. Another new factor was thinner CCT, with results possibly indicating a preferential CCT effect with higher IOP.
基于早期显性青光眼试验（EMGT）的所有患者，确定该试验结束时的病情进展因素，并分别评估基线眼压（IOP）较高和较低的患者（中位数分割）。
临床试验参与者队列。
早期开角型青光眼患者被随机分为氩激光小梁成形术联合倍他洛尔组（n = 129）或不立即治疗组（n = 126），每3个月检查一次，为期11年。
Cox比例风险分析，以风险比（HRs）和95%置信区间（CIs）表示。
根据视野和视盘照相标准定义的病情进展时间。
随访结束时（中位数为8年）总体病情进展率为67%。治疗使病情进展风险降低约一半（HR，0.53；95%CI，0.39 - 0.72）；基线IOP较高和较低的患者结果相似（HR分别为0.41和0.55）。如先前报道，基线病情进展因素（HR，1.51 - 2.12；P<0.01）为较高的IOP、剥脱、双侧疾病和年龄较大。新的基线预测因素为所有患者较低的眼收缩期灌注压（≤160 mmHg；HR，1.42；95%CI，1.04 - 1.94），基线IOP较高患者的心血管疾病史（HR，2.75；95%CI，1.44 - 5.26），以及基线IOP较低患者较低的收缩压（≤125 mmHg；HR，0.46；95%CI，0.21 - 1.02）。基线后病情进展因素为随访时的IOP水平，所有患者每毫米汞柱平均升高12%至13%（每升高1 mmHg的HR为1.12 - 1.13），基线IOP较高和较低的患者结果相似（每升高1 mmHg的HR分别为1.15和1.13）。视盘出血（每增加1%频率的HR，1.02；95%CI，1.01 - 1.03）也可预测病情进展。较薄的中央角膜厚度（CCT）（每降低40微米的HR，1.25；95%CI，1.01 - 1.55）是一个新的显著因素，在基线IOP较高的患者中观察到这一结果（每降低40微米的HR，1.42；95%CI，1.05 - 1.92），而在基线IOP较低的患者中未观察到，存在显著的IOP - CCT相互作用。
无论基线IOP如何，治疗和随访期间的IOP对病情进展仍有显著影响。其他显著因素如年龄、双侧性、剥脱和视盘出血，如先前确定的那样。较低的收缩期灌注压、较低的收缩压和心血管疾病史成为新的预测因素，提示血管在青光眼病情进展中起作用。另一个新因素是较薄的CCT，结果可能表明较高IOP时CCT有优先影响。
