Hyman Leslie, Heijl Anders, Leske M Cristina, Bengtsson Boel, Yang Zhongming
Division of Epidemiology, Department of Preventive Medicine, Stony Brook University, Stony Brook, NY 11790-8036, USA.
Arch Ophthalmol. 2010 May;128(5):601-7. doi: 10.1001/archophthalmol.2010.78.
To characterize intraocular pressure (IOP) changes during 6 years of follow-up among patients with early, newly diagnosed glaucoma randomized to no initial treatment in the Early Manifest Glaucoma Trial (control group) and to evaluate factors associated with IOP changes in this group.
Early Manifest Glaucoma Trial control patients, aged 50 to 80 years at baseline, were followed up for 6 years or to the time of progression, when treatment could be initiated. After baseline, patients were followed up every 3 months with comprehensive ophthalmologic examinations, including Goldmann applanation tonometry. Change in IOP over 6 years was assessed by linear regression analyses.
At baseline, the median IOP of this cohort (N = 118) was 20.8 mm Hg and was higher for the 15 patients with exfoliation glaucoma (24.0 mm Hg vs 20.0 mm Hg for others; P = .005). In patients without exfoliation glaucoma, IOP remained stable during follow-up (median IOP change of -0.01 mm Hg/y; interquartile range, 0.85 mm Hg/y). In comparison, patients with exfoliation glaucoma showed a significantly larger median change of 0.96 mm Hg/y (interquartile range, 3.11 mm Hg/y) (P = .004). In the overall cohort, the only factor related to IOP change was exfoliation glaucoma (P < .001). Among patients without exfoliation glaucoma, no factors were associated with IOP change.
In patients with early glaucoma, IOP remained stable without treatment during a 6-year period, regardless of baseline IOP, except for patients with exfoliation glaucoma, where IOP increased by almost 1 mm Hg annually. No factors, aside from exfoliation glaucoma, were related to longitudinal changes in IOP. These new natural history data may be useful in guiding management decisions for glaucoma treatment, particularly in patients with early disease or with exfoliation glaucoma.
在早期青光眼试验（对照组）中，对随机分配至未进行初始治疗的早期新诊断青光眼患者随访6年期间的眼压（IOP）变化进行特征描述，并评估该组中与眼压变化相关的因素。
早期青光眼试验对照组患者，基线年龄为50至80岁，随访6年或至病情进展时开始治疗。基线后，每3个月对患者进行一次全面眼科检查，包括Goldmann压平眼压测量法。通过线性回归分析评估6年期间的眼压变化。
基线时，该队列（N = 118）的眼压中位数为20.8 mmHg，15例剥脱性青光眼患者的眼压更高（24.0 mmHg，其他患者为20.0 mmHg；P = 0.005）。在无剥脱性青光眼的患者中，随访期间眼压保持稳定（眼压中位数变化为-0.01 mmHg/年；四分位间距为0.85 mmHg/年）。相比之下，剥脱性青光眼患者的眼压中位数变化显著更大，为0.96 mmHg/年（四分位间距为3.11 mmHg/年）（P = 0.004）。在整个队列中，与眼压变化相关的唯一因素是剥脱性青光眼（P < 0.001）。在无剥脱性青光眼的患者中，没有因素与眼压变化相关。
在早期青光眼患者中，除剥脱性青光眼患者眼压每年升高近1 mmHg外，无论基线眼压如何，未经治疗的情况下眼压在6年期间保持稳定。除剥脱性青光眼外，没有其他因素与眼压的纵向变化相关。这些新的自然史数据可能有助于指导青光眼治疗的管理决策，特别是对于早期疾病患者或剥脱性青光眼患者。
