Abstract :
PURPOE: To invetigate the aociation of pre-intervention and pot-intervention patient and eye characteritic with failure of argon laer trabeculoplaty (ALT) and trabeculectomy.
DEIGN: Cohort tudy of participant in the Advanced Glaucoma Intervention tudy.
METHOD: Thi multicenter tudy took place between 1988 and 2001. Between 1988 and 1992, 789 eye of 591 patient aged 35 to 80 year with advanced glaucoma were randomized into one of two urgical treatment equence: argon laer trabeculoplaty (ALT)-trabeculectomy-trabeculectomy or trabeculectomy-ALT-trabeculectomy. Upon tudy-defined failure (baed on maximum medication, utained intraocular preure (IOP) elevation, viual field defect, and dik rim deterioration) of each intervention, patient were offered the ubequent intervention. Potential follow-up wa 8 to 13 year. Thi report i baed on data from 779 eye that had at leat 3 month of follow-up. The main outcome meaure are failure of ALT and trabeculectomy, whether a firt or econd intervention. Effect ize i meaured by the hazard ratio (HR) and it correponding 95% confidence interval (CI) obtained from Cox multiple regreion analyi, where HR correpond to the coefficient of change in rik aociated with a unit increae in a factor. For binary factor, thi correpond to the change in rik in eye with the factor relative to the rik in eye without the factor.
REULT: Pre-intervention factor aociated with failure of ALT are younger age (HR = 0.98, CI = 0.96–0.99, P = .009) and higher IOP (1.11, 1.08–1.15, P < .001). Pre-intervention factor aociated with failure of trabeculectomy are younger age (HR = 0.97, CI = 0.95–0.99, P = .005) and higher IOP (1.04, 1.01–1.06, P = .002), a well a diabete (2.86, 1.88–4.36, P < .001) and any potoperative complication (1.99, 1.35–2.93, P < .001). Individual potoperative complication ignificantly aociated with increaed rik of failure of trabeculectomy are elevated IOP (3.4, 1.9–6.1, P < .001) and marked inflammation (2.4, 1.3–4.6, P = .006).
CONCLUION: In thi tudy, ALT failure wa aociated with younger age and higher pre-intervention IOP. Trabeculectomy failure wa aociated with younger age, higher pre-intervention IOP, diabete, and one or more potoperative complication, particularly elevated IOP and marked inflammation.
