New York University School of Medicine, New York, NY, USA.
Am J Ophthalmol. 2010 Feb;149(2):258-264.e2. doi: 10.1016/j.ajo.2009.09.010.
Incisional glaucoma surgical procedures produce greater intraocular pressure (IOP) reduction and less IOP variability than medical treatment. We sought to determine the efficacy of glaucoma surgery in decreasing localized and global rates of visual field (VF) progression.
Retrospective, interventional case series.
Subjects in the New York Glaucoma Progression Study with glaucomatous optic neuropathy, repeatable VF loss, and 10 or more Swedish interactive threshold algorithm standard VF examinations were assessed for eligibility. Patients who underwent successful glaucoma surgery (not requiring further surgical intervention and IOP < 18 mm Hg) in either eye and who were followed up for at least 2 years before and after surgery were enrolled. Automated pointwise linear regression analysis was used to calculate global and localized rates of progression before and after surgery. Eyes with other ocular conditions likely to affect the VF and an insufficient number of VF to create a slope before and after surgery were excluded. Comparisons were performed within the same eyes before and after surgery (Student paired t test).
We enrolled 28 eyes of 28 patients (mean age, 61.2 +/- 14.5 years). The mean number +/- standard deviation of VF was 13.4 +/- 2.3, spanning 7.1 +/- 1.2 years (range, 4 to 9 years). Mean IOP +/- standard deviation decreased from 19.0 +/- 3.9 mm Hg before surgery to 11.3 +/- 3.7 mm Hg after surgery (40% reduction; P < .01). Mean global progression rates decreased from -1.48 +/- 1.4 dB/year before surgery to -0.43 +/- 0.8 dB/year after surgery (70% reduction; P = .01). Twelve eyes (42.8%) had at least 1 significantly progressing point before surgery, whereas only 2 (7.1%) had at least 1 progressing point after surgery. Each 1 mm Hg of IOP reduction after surgery resulted in a 0.1 dB/year decrease in the global rate of progression.
Successful IOP reduction after glaucoma surgery greatly reduces both the number of progressing points and the localized and general rates of VF progression.
与药物治疗相比，切口性青光眼手术可降低更高的眼压（IOP）并减少 IOP 变化。我们旨在确定青光眼手术在降低局部和全球视野（VF）进展率方面的效果。
回顾性、干预性病例系列。
纽约青光眼进展研究中的受试者具有青光眼视神经病变、可重复的 VF 丧失以及 10 次以上的瑞典互动阈值算法标准 VF 检查，以确定其合格性。在任何一只眼接受成功的青光眼手术（无需进一步手术干预且 IOP <18mmHg）且在手术前后至少随访 2 年的患者被纳入研究。使用自动逐点线性回归分析来计算手术前后的全局和局部进展率。排除了可能影响 VF 的其他眼部疾病以及在手术前后没有足够数量的 VF 来创建斜率的眼睛。在手术前后的同一眼睛中进行比较（学生配对 t 检验）。
我们纳入了 28 名患者的 28 只眼（平均年龄 61.2±14.5 岁）。VF 的平均数量±标准差为 13.4±2.3，跨度为 7.1±1.2 年（范围为 4 至 9 年）。平均 IOP±标准差从手术前的 19.0±3.9mmHg 降至手术后的 11.3±3.7mmHg（降低 40%；P<.01）。平均全球进展率从手术前的-1.48±1.4dB/年降至手术后的-0.43±0.8dB/年（降低 70%；P=.01）。手术前有 12 只眼（42.8%）至少有 1 个明显进展点，而手术后只有 2 只眼（7.1%）至少有 1 个进展点。手术后每降低 1mmHg 的 IOP 可使全球进展率降低 0.1dB/年。
青光眼手术后成功降低眼压可大大降低进展点的数量以及局部和总体 VF 进展率。
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