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醋酸氟轻松植入或全身皮质类固醇激素治疗非感染性葡萄膜炎患者的纵向视觉相关生活质量研究

Sugar, E.A., Venugopal, V., Thorne, J.E., et al.

期刊名称:Ophthalmology

卷期:2017年第124卷第11期

摘要

摘要:目的:旨在评估非感染性葡萄膜炎患者的纵向视觉相关生活质量(VRQoL)。设计:使用随机对照试验数据的随机对照研究。研究对象:入选多中心类固醇激素治疗试验及随访研究的活动性或近期活动性中间葡萄膜炎,后葡萄膜炎或葡萄膜炎患者。方法:每半年评估一次随机分组后头前三年25项全国眼科研究所视觉功能问卷(NEI-VFQ-25)数据。由于VRQoL轨迹存在实质性差异,因此通过分配治疗(129个植入物:126个系统治疗)进行分层。主要观察指标:主要观察指标为随机分组后3年内的NEI-VFQ-25综合评分。结果:两个治疗组个体随访3年后的NEI-VFQ-25评分改善类似(种植组:11.9; 95%可信区间[CI]8.6-15.2; P <0.001;全身组:9.0; 95CI5.6-12.3; P <0.001;相互作用P = 0.21)。种植组个体在前6个月中显示出明显的改善,随后评分稳定,而全身组中个体在随访期间显示出稳定的改善。初始视力和视野较差与两个治疗组初始NEI-VFQ-25评分较低相关。在全身组中,这些差异在整个随访过程中保持不变。在植入组中,初始视力低于20/40患者的NEI-VFQ-25得分较视敏度为20/40患者存在-7分(95CI-15.00.9)范围的改善,有临床意义但无统计学意义(P = 0.081)。基于敏感性分析结果显示相似的模式。结论:两个治疗组在NEI-VFQ-25得分方面均显示出明显改善;然而,植入组的改善是立即的,而全身组是逐渐的改善。较差的视觉功能与NEI-VFQ-25评分初始差异显着相关。然而,只有视力不良的种植组的个体能够在3年内克服最初的缺陷。

PURPOSE:To evaluate longitudinal vision-related quality of life (VRQoL) in patients with noninfectious uveitis.DESIGN:Cohort study using randomized controlled trial data.PARTICIPANTS:Patients with active or recently active intermediate uveitis, posterior uveitis, or panuveitis enrolled in the Multicenter Steroid Treatment Trial and Follow-up Study.METHODS:Data from the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) for the first 3 years after randomization were evaluated semiannually. Analyses were stratified by assigned treatment (129implants vs. 126 systemic therapies) because of substantial differences in the trajectories of VRQoL. The impact of baseline measurements of visual function (visual acuity and visual field), demographics, and disease characteristics was assessed using generalized estimating equations.MAIN OUTCOME MEASURES:Primary outcome was the NEI-VFQ-25 composite score over 3 years after randomization.RESULTS:Individuals in both treatment groups showed similar improvement in NEI-VFQ-25 scores after 3 years of follow-up (implant: 11.9 points; 95% confidence interval [CI], 8.6-15.2; P < 0.001; systemic: 9.0 points; 95% CI, 5.6-12.3; P < 0.001; P= 0.21 for interaction). Individuals in the implant group showed a substantial improvement during the first 6 months followed by stable scores, whereas individuals in the systemic group showed a steady improvement over the course of follow-up. Worse initial visual acuity and visual fields were associated with lower initial NEI-VFQ-25 scores for both treatment groups. In the systemic group, these differences were maintained throughout follow-up. In the implant group, individuals with initial visual acuity worse than 20/40 showed additional improvement in NEI-VFQ-25 score to come within-7 points (95% CI,-15.0 to 0.9) of those with visual acuity 20/40 or better initially, a clinically meaningful but not statistically significant difference (P= 0.081). Results based on sensitivity analyses showed similar patterns.CONCLUSIONS:Both treatment groups demonstrated significant improvements in NEI-VFQ-25 scores; however, the improvement was immediate for the implant group as opposed to gradual for the systemic group. Poorer visual function was associated significantly with initial differences in NEI-VFQ-25 scores. However, only individuals in the implant group with poor visual acuity were able to overcome their initial deficits by the end of 3 years.


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