英国诺丁汉大学Anthony J King团队研究了原发性小梁切除术治疗晚期青光眼的疗效。2021年5月12日，该研究发表在《英国医学杂志》上。
为了探讨初级小梁切除术或初级药物治疗是否能提高晚期青光眼患者的生活质量、临床疗效和安全性，研究组进行了一项实用的多中心、随机对照试验。2014年6月3日至2017年5月31日，研究组在英国的27个青光眼二级护理部门招募了453名至少一只眼出现新诊断的晚期开角型青光眼（Hodapp分类）的成人。
将其随机分组，其中227例接受丝裂霉素C增强小梁切除术，226例接受眼压下降的升级医疗管理。主要结局为24个月时用视觉功能问卷-25（VFQ-25）测量视力特异性生活质量。次要结局包括一般健康状况、青光眼相关生活质量、临床疗效（眼压、视野、视力）和安全性。
24个月时，小梁切除术组和药物治疗组的VFQ-25平均得分分别为85.4分和84.5分，差异不显著。小梁切除术组的平均眼压为12.4 mmHg，药物治疗组的平均眼压为15.1 mmHg，组间差异显著。小梁切除术组中有88例（39%）发生不良事件，药物治疗组中有100例（44%）。严重的副作用很少见。
研究结果表明，初级小梁切除术与初级药物治疗相比，具有相似的生活质量和安全性结果，并获得了较低的眼压。
附：英文原文
Title: Primary trabeculectomy for advanced glaucoma: pragmatic multicentre randomised controlled trial (TAGS)
Author: Anthony J King, Jemma Hudson, Gordon Fernie, Ashleigh Kernohan, Augusto Azuara-Blanco, Jennifer Burr, Tara Homer, Hosein Shabaninejad, John M Sparrow, David Garway-Heath, Keith Barton, John Norrie, Alison McDonald, Luke Vale, Graeme MacLennan
Issue&Volume: 2021/05/12
Abstract:
Objective To determine whether primary trabeculectomy or primary medical treatment produces better outcomes in term of quality of life, clinical effectiveness, and safety in patients presenting with advanced glaucoma.
Design Pragmatic multicentre randomised controlled trial.
Setting 27 secondary care glaucoma departments in the UK.
Participants 453 adults presenting with newly diagnosed advanced open angle glaucoma in at least one eye (Hodapp classification) between 3 June 2014 and 31 May 2017.
Interventions Mitomycin C augmented trabeculectomy (n=227) and escalating medical management with intraocular pressure reducing drops (n=226)
Main outcome measures Primary outcome: vision specific quality of life measured with Visual Function Questionnaire-25 (VFQ-25) at 24 months. Secondary outcomes: general health status, glaucoma related quality of life, clinical effectiveness (intraocular pressure, visual field, visual acuity), and safety.
Results At 24 months, the mean VFQ-25 scores in the trabeculectomy and medical arms were 85.4 (SD 13.8) and 84.5 (16.3), respectively (mean difference 1.06, 95% confidence interval 1.32 to 3.43; P=0.38). Mean intraocular pressure was 12.4 (SD 4.7) mm Hg for trabeculectomy and 15.1 (4.8) mm Hg for medical management (mean difference 2.8 (3.8 to 1.7) mm Hg; P<0.001). Adverse events occurred in 88 (39%) patients in the trabeculectomy arm and 100 (44%) in the medical management arm (relative risk 0.88, 95% confidence interval 0.66 to 1.17; P=0.37). Serious side effects were rare.
Conclusion Primary trabeculectomy had similar quality of life and safety outcomes and achieved a lower intraocular pressure compared with primary medication.
DOI: 10.1136/bmj.n1014
Source: https://www.bmj.com/content/373/bmj.n1014
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj
本期文章：《英国医学杂志》：Online/在线发表
