Fogagnolo Paolo, McNaught Andrew, Centofanti Marco, Rossetti Luca, Orzalesi Nicola
G. B. Bietti Foundation-IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Rome, Italy.
Invest Ophthalmol Vis Sci. 2007 Oct;48(10):4557-63. doi: 10.1167/iovs.06-1496.
To investigate changes in the variability of white-on-white perimetry in patients with glaucoma who are undergoing surgical or medical reduction of intraocular pressure (IOP).
This retrospective study included 67 eyes of 50 patients who underwent trabeculectomy (25 eyes) or medical IOP reduction (25 eyes) about midway through the follow-up; 17 fellow eyes of the surgical group were the control group. Their pre- and postinterventional visual fields were analyzed (full-threshold, 24-2 program, Humphrey Field Analyzer; Carl Zeiss Meditec, Inc., Oberkochen, Germany) to evaluate changes in short-term fluctuation (SF) and test-retest variability (TRV). The longest follow-up periods possible were considered, provided that glaucoma was stable (as confirmed by intraocular pressure, optic nerve appearance and visual field). For each patient and in each period, TRV was defined as the mean of the square roots of the mean variances in each of the 54 locations.
Trabeculectomy reduced mean IOP (5.7 +/- 4.7 mm Hg; P < 0.0001), IOP fluctuations (-2.9 +/- 4.4 mm Hg; P = 0.003), and eye drop use (-1.3 +/- 1.4; P = 0.0001). Pre- and postsurgical SF was 3.0 +/- 1.1 and 2.7 +/- 1.0 dB, respectively (P = 0.34), and pre- and postsurgical TRV was 2.90 +/- 0.97 and 2.53 +/- 0.86 dB, with a decrease of 0.37 dB (P = 0.0006). In the medical group, mean IOP decreased (-4.0 +/- 2.0 mm Hg; P < 0.0001) as did IOP fluctuation (-3.7 +/- 4.1 mm Hg; P = 0.0008), but eye drop use increased by 1.0 +/- 0.6 (P < 0.0001). TRV (2.58 +/- 0.53 vs. 2.72 +/- 0.67 dB; P = 0.37) and SF (2.3 +/- 0.8 vs. 2.3 +/- 0.8 dB; P = 0.89) remained stable during the study. There was no change in perimetric variability throughout the study in the control group. The individual reductions in TRV were higher in the surgical group than in the medical (P = 0.004) or control (P = 0.015) groups. No differences were found between the control and medical groups (P = 0.55).
After trabeculectomy, there was a small but statistically significant reduction in long-term perimetric variability compared with the medical and control groups. There were no significant changes in short-term variability in any of the groups during the study.
研究青光眼患者在接受手术或药物降低眼压（IOP）过程中，白色视野检查变异性的变化。
这项回顾性研究纳入了50例患者的67只眼，其中25只眼接受小梁切除术，25只眼接受药物降低眼压治疗，均在随访约中期进行；手术组的17只对侧眼作为对照组。分析干预前后的视野（全阈值，24-2程序，Humphrey视野分析仪；卡尔蔡司医疗技术公司，德国奥伯科亨），以评估短期波动（SF）和重测变异性（TRV）的变化。在青光眼病情稳定（通过眼压、视神经外观和视野确认）的前提下，尽可能采用最长的随访期。对于每位患者和每个时期，TRV定义为54个位置中每个位置平均方差平方根的平均值。
小梁切除术降低了平均眼压（5.7±4.7mmHg；P<0.0001）、眼压波动（-2.9±4.4mmHg；P = 0.003）以及眼药水使用量（-1.3±1.4；P = 0.0001）。手术前后的SF分别为3.0±1.1和2.7±1.0dB（P = 0.34），手术前后的TRV分别为2.90±0.97和2.53±0.86dB，降低了0.37dB（P = 0.0006）。在药物治疗组，平均眼压降低（-4.0±2.0mmHg；P<0.0001），眼压波动也降低（-3.7±4.1mmHg；P = 0.0008），但眼药水使用量增加了1.0±0.6（P<0.0001）。在研究期间，TRV（2.58±0.53对2.72±0.67dB；P = 0.37）和SF（2.3±0.8对2.3±0.8dB；P = 0.89）保持稳定。在整个研究过程中，对照组的视野变异性没有变化。手术组TRV的个体降低幅度高于药物治疗组（P = 0.004）或对照组（P = 0.015）。对照组和药物治疗组之间未发现差异（P = 0.55）。
与药物治疗组和对照组相比，小梁切除术后长期视野变异性虽有小幅但具有统计学意义的降低。在研究期间，任何一组的短期变异性均无显著变化。
