Abstract :
PURPOE: To compare in eye of black and white patient the progreion of glaucoma after failure of medical therapy and upon tart of urgical intervention.
DEIGN: Cohort tudy analyi of data from a randomized clinical trial.
METHOD: Thi multicenter tudy included open-angle glaucoma patient who had failed medical therapy: 451 eye of 332 black patient, 325 eye of 249 white patient. Eye were randomly aigned to an argon laer trabeculoplaty (ALT)-trabeculectomy-trabeculectomy (ATT) equence or a trabeculectomy-ALT-trabeculectomy (TAT) equence; they had been followed for 7 to 11 year at databae cloure. Main outcome meaure were decreae of viual field (DVF), utained decreae of viual field (DVF), decreae of viual acuity (DVA), utained decreae of viual acuity (DVA), and failure of firt urgical glaucoma intervention. tatitical method included logitic regreion to obtain average adjuted black-white odd ratio for binary outcome, and Cox regreion to etimate adjuted black-white rik ratio for time-to-event outcome.
REULT: In the ATT equence black were at lower rik than white of failure of firt intervention (ALT, RR = 0.68, P = 0.040). In the TAT equence black were at higher rik than white of failure of the firt intervention (trabeculectomy, RR = 1.79, P = 0.033), of intraocular preure ≥18 mm Hg (average OR = 1.41, P = 0.026), and of DVF (average OR = 1.78, P = 0.007). In both treatment equence, the average number of precribed medication wa greater for black than white (P ≤ 0.002).
CONCLUION: The reult upport the hypothei that after failure of medical therapy and upon initiation of urgical intervention, an initial intervention with trabeculectomy retard the progreion of glaucoma more effectively in white than in black patient. The data provide a weak uggetion that an initial urgical intervention with ALT retard the progreion of glaucoma more effectively in black than in white patient
