拉坦前列素、曲伏前列素和噻吗洛尔治疗原发性开角型青光眼的疗效比较分析

目的：比较拉坦前列素、曲伏前列素及噻吗洛尔滴眼液治疗原发性开角型青光眼（ POAG）的效果。方法将收治的120例患者随机分为A、B、C组,每组均为40例,其中A 组患者给予拉坦前列素滴眼液;B组患者给予曲伏前列素滴眼液;C组患者给予马来酸噻吗洛尔滴眼液,A、B组均为每天晚上约20：00给药1次,每次1滴,疗程为4周,C组为每天早上约08：00给药1次,每次1滴,疗程为4周。结果三组患者治疗前比较,眼压无统计学差异（ P ＞0．05）,三组患者用药治疗4周眼压值均有显著下降,用药前后差异具有统计学意义（ P ＜0．05）;拉坦前列素和曲伏前列素两种滴眼液组间治疗无显著性差异（ P ＞0．05）,但与噻吗洛尔治疗分别进行组间效果比对具有显著性差异（ P ＜0．05）。结论拉坦前列素、曲伏前列素及噻吗洛尔滴眼液治疗POAG在一个疗程内（4周）均能有效降低眼压,疗效持久,且两种前列素降眼压作用明显优于噻吗洛尔滴眼液治疗效果。     

噻吗洛尔和布林佐胺联合曲伏前列素治疗原发性开角型青光眼与高眼压患者的临床研究

目的比较噻吗洛尔和布林佐胺辅助曲伏前列素治疗原发性开角型青光眼(primary open-angle glaucoma,POAG)或高眼压(ocular hypertension,OHT)患者的效果。方法将使用曲伏前列素单剂药物治疗6周后眼压>18mmHg(1kPa=7.5mm-Hg)的POAG及OHT患者随机分为治疗组和对照组。治疗组40例(40眼)加入10g·L-1布林佐胺滴眼液(每日2次),对照组40例(40眼)加入5g·L-1噻吗洛尔滴眼液(每日2次)。随访2周、8周、14周、20周、26周的眼压、血压、心率,观察眼部症状和体征,26周检测与基线对应的相关参量,包括视野、视觉电生理、视网膜神经纤维层厚度、视盘盘沿面积、泪液功能等。计算26周时眼压≤18mmHg患者百分比。结果两组眼压与基线比较均有明显下降,差异均有显著统计学意义(均为P<0.01)。治疗组降眼压持续平稳,对照组眼压于20周后出现上升趋势。24h眼压描记显示治疗组降眼压稳定,昼夜眼压平稳,对照组夜间眼压控制欠佳。2组对患者血压无影响,治疗组对患者心率无影响,对照组在联合用药20周始出现心率抑制。联合用药后对照组视野光敏感度下降,泪膜稳定性下降,治疗组无明显异常。治疗组常见的副作用是眼部刺激症状、味觉异常、口干等,对照组副作用是眼异物感、干涩等。结论曲伏前列素单剂治疗不足时,添加布林佐胺和噻吗洛尔均能进一步降低眼压,布林佐胺长期及短期眼压波动幅度均比噻吗洛尔小,局部及全身副作用小。     

卡替洛尔和噻吗心安降低眼内压的临床观察

观察2％卡替洛尔滴眼液的临床疗效。（1）16例32眼正常人点1滴药后，0．5小时出现显著的眼压下降。4小时眼压下降幅度最大，眼压下降1．78mmHg，为基础眼压的10．40％。（2）应用双盲法比较2％卡替洛尔和0．5％噻吗心安连续用药8周对41例82眼开角型青光眼的临床疗效，结果表明①卡替洛尔和噻吗心安用药后均可使青光眼患者眼压明显下降（P＜0．05），眼压下降率分别为用药前基础眼压的12．10％（2．47mmHg）和14．46％（3．02mmHg）；②卡替洛尔的降眼压效果与噻吗心安相比无显著性差异（P＞0．4）；③两种药物对血压、脉搏和瞳孔直径无明显影响（P＞0．05），也未发现明显的主观不适感觉。本文结果提示：卡替洛尔是一种新的治疗青光眼的有效药物。     

曲伏前列素与噻吗洛尔降眼压效果的对比研究

目的观察曲伏前列素(苏为坦)降眼压(intraocular pressure,IOP)效果及安全性。方法以噻吗洛尔为对照采用随机、单盲、平行对照试验,选取原发性开角型青光眼、高IOP症和抗青光眼术后高IOP患者。试验组30例(30眼)滴用曲伏前列素滴眼液,每天1次;对照组20例(20眼)滴用噻吗洛尔滴眼液,每天2次,共观察4周。观察的指标包括IOP、视力、血压、脉搏、眼部症状和体征以及不良反应。结果曲伏前列素与噻吗洛尔相比昼夜降IOP效果稳定、持续降IOP效果恒定。曲伏前列素组有16例出现了结膜充血,有2例出现睫毛增粗增长,1例眼睑皮肤颜色增加,无其他明显不良反应。结论曲伏前列素滴眼液对控制IOP是有效、稳定和安全的,有望成为理想的一线抗青光眼药物。     

固定联合制剂拉坦前列素/噻吗洛尔早晨与晚间应用的比较

目的:对早晨与晚间应用固定联合制剂拉坦前列素/噻吗洛尔(适利加),1次/d治疗开角型青光眼和高眼压症疗效及其安全性的比较。方法:本研究为前瞻性、观察性的临床研究,患者入组前先进行全面的眼科检查,并进行24h眼压测定,早晨开始应用固定联合制剂拉坦前列素/噻吗洛尔,1次/d,1mo后随访,测量其24h眼压曲线,记录就诊的观察结果及副作用。停用1wk后嘱患者改为晚间应用固定联合制剂拉坦前列素/噻吗洛尔,1次/d,应用1mo后再测量24h眼压曲线,记录就诊的观察结果及副作用,比较两次随访中24h眼压及副作用的差别。结果:本研究共入组32例患者,早晨组平均眼压(17.3±3.1mmHg)和晚间组平均眼压(17.1±2.7mmHg)均较基线眼压(21.1±3.3mmHg)降低(P<0.01)。在6∶00相比较,晚间组的平均眼压(16.4±2.3mmHg)较早晨组的平均眼压(17.9±2.8mmHg)明显降低(P<0.05)。晚间组应用固定联合制剂拉坦前列素/噻吗洛尔可以维持较低的白天眼压,早晨组应用固定联合制剂拉坦前列素/噻吗洛尔可以维持较低的夜间眼压。晚间应用固定联合制剂拉坦前列素/噻吗洛尔平均24h眼压波动(3.6±1.6mmHg),较早晨组(4.4±1.6mmHg)低(P<0.05)。两组副作用均无统计学差异(P>0.05)。结论:本研究显示早晨应用固定联合制剂拉坦前列素/噻吗洛尔与晚间应用固定联合制剂拉坦前列素/噻吗洛尔1次/d均能有效的降低24h眼压,患者的耐受性好,副作用少,但晚间应用固定联合制剂拉坦前列素/噻吗洛尔更能有效的维持24h眼压的稳定。     

联合用药对高眼压型POAG患者视盘参数及视网膜神经纤维层厚度的影响

目的:研究噻吗洛尔与拉坦前列素联合应用对高眼压型原发性开角型青光眼(primary open angle glaucoma,POAG)患者视盘参数及视网膜神经纤维层厚度的影响,为临床研究提供指导.方法:将2013-11/2015-11期间于我院进行治疗的240例336眼高眼压型POAG患者按随机数字表法将患者分为两组,其中对照组120例170眼,观察组120例166眼.对照组患者仅采用拉坦前列素治疗,观察组则采用噻吗洛尔联合拉坦前列素进行治疗.观察治疗后3 mo内患者治疗效果,测量患者视盘参数和视网膜神经纤维层厚度,随访关注1a内患者不良反应发生率.结果:观察组和对照组患者治疗后的改善率分别为97.6%和80.6%,观察组疗效明显优于对照组,两组比较差异有统计学意义(P<0.05);治疗后两组患者眼部盘沿面积、盘沿容积、视盘容积和水平杯盘直径比均有所升高,差异有统计学意义(P<0.05),其中观察组显著高于对照组,差异有统计学意义(P<0.05),而两组患者的垂直杯盘直径明显下降,差异有统计学意义(P<0.05),观察组显著低于对照组,差异具有统计学意义(P<0.05);两组患者治疗期间眼睛干涩、角膜浸润、结膜充血、视觉模糊等并发症发生率比较差异无统计学意义(P>0.05),1a内随访患者也无其他不良反应发生.结论:采用噻吗洛尔与拉坦前列素联合应用治疗高眼压型POAG患者,患者病情有明显好转,视力得到提高,其视盘参数和视网膜神经纤维层厚度也有所改善.     

四种前列腺素类药物的降眼压疗效和耐受性对比研究

目的　探讨四种前列腺素类药物治疗原发性开角型青光眼（primary open-angle glaucoma，POAG）的疗效和耐受性差异。方法　采用随机平行试验，64例(128眼)POAG患者随机分成4组，分别使用贝美前列素(贝美前列素组)、拉坦前列素（拉坦前列素组）、曲伏前列素（曲伏前列素组）和他氟前列素（他氟前列素组）滴眼液治疗，观察并比较4组患者用药前和用药后1个月、3个月和6个月的眼压、眼部检查和眼表疾病指数（ocular surface disease index，OSDI）评分。结果　贝美前列素组用药前眼压为（26.1±6.2）mmHg（1 kPa=7.5 mmHg），用药后1个月、3个月和6个月眼压分别为（17.1±3.4）mmHg、（15.6±4.2）mmHg、（15.5±2.9）mmHg，与用药前比较，差异均有统计学意义（t=17.408、13.016、12.352，均为P＜0.001）。拉坦前列素组用药前眼压为（24.7±2.4）mmHg，用药后1个月、3个月和6个月眼压分别为（16.3±3.0）mmHg、（17.0±3.8）mmHg、（17.4±2.6）mmHg，与用药前比较，差异均有统计学意义（t=12.238、13.365、16.140，均为P＜0.001）。曲伏前列素组用药前眼压为（24.4±1.9）mmHg，用药后1个月、3个月和6个月眼压分别为（16.3±2.0）mmHg、（17.4±1.3）mmHg、（14.9±1.1）mmHg，与用药前比较，差异均有统计学意义（t=12.109、14.451、11.732，均为P＜0.001）。他氟前列素组用药前眼压为（25.2±2.3）mmHg，用药后1个月、3个月和6个月眼压分别为（17.2±3.1）mmHg、（17.0±2.1）mmHg、（18.1±2.4）mmHg，与用药前比较，差异均有统计学意义（t=10.540、16.129、14.006，均为P＜0.001）。拉坦前列素组患者睫毛增长和虹膜变色的发生率最高，4组患者的结膜充血和角膜炎的发生率相似。用药6个月后患者的OSDI评分贝美前列素组（21.8±11.1）分、拉坦前列素组（32.1±24.1）分、曲伏前列素组（10.7±5.7）分、他氟前列素组（25.6±6.3）分，曲伏前列素组患者的OSDI评分显著低于其他3组，差异均有统计学意义（均为P＜0.05）。结论　四种前列腺素类药物均能显著降低POAG患者眼压，曲伏前列素耐受性较好，拉坦前列素的耐受性最差。     

曲伏前列素与噻吗洛尔治疗原发性开角型青光眼疗效的Meta分析

目的:系统评价曲伏前列素滴眼液与噻吗洛尔滴眼液治疗中国成人原发性开角型青光眼(POAG)的血流动力学、散光度及细胞因子的变化。方法:检索PubMed, EMbase, Cochrane Library, Web of Science,中国期刊全文数据库(CNKI),中国生物医学文献数据库(CBM),维普数据库及万方数据库2015-01-01/2020-12-31收录的有关曲伏前列素与噻吗洛尔治疗中国成人POAG的随机对照试验(RCTs)和回顾性队列研究。按照纳入与排除标准筛选文献,用Cochrane风险评估工具对RCTs进行质量评价,用NOS量表对回顾性队列研究进行质量评价。采用Review Manager 5.4软件进行Meta分析并生成加权均数差(WMD)为效应量对比曲伏前列素与噻吗洛尔在视网膜中央动脉(CRA)和睫状后短动脉(PCA)的收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)及血管阻力指数(RI)、散光度、血浆内皮素-1(ET-1)、血清基质金属蛋白酶(MMP)、房水基质金属蛋白酶抑制因子-2(TIMP-2)、血清TIMP-2中的差异。结果:共纳入8项RCTs, ...     

噻吗洛尔滴眼液对LASIK术后屈光回退的应用

目的探讨噻吗洛尔滴眼液对准分于激光原位角膜磨馕术（LASIK）术后屈光回退的治疗效果。方法2007年8章至2008年8月在我院屈光手术中心接受LASIK手术治疗的近视821例（1621眼）,随访1年余。发生屈光回退者有54例（88眼）。随机分为2组：一组使用0．25％马来酸噻吗洛尔滴眼液进行治疗,另一组（即埘照组）使用0．1％普拉洛芬滴眼液治疗。治疗时间均为3个月,治疗结束后将两组的各项指标（视力提高行数、眼压变化程度）进行分析比较：结果视力提高行数：噻吗洛尔组视力提高1～4行,平均（3．17±1．16）行;对照组提高-2～2行,平均（-0．12±0．93）行,两组差异有统计学意义（t=5．46,P〈0．01）。眼压变化：噻吗洛尔组眼压下降2～6mmHg,平均（4．084-0．34）mmHg,对照组眼压下降-1～1mmHg,平均（0．23±0．38）mmHg;两组差异何统计学意义（t=11．16,P〈0．01）．结论0．25％马来酸噻吗洛尔滴眼液对LASIK术后的屈光回退具有明显的治疗效果,是一种简单、易行、有效的治疗厅法。     

曲伏前列素滴眼液治疗原发性开角型青光眼和高眼压症

目的：研究曲伏前列素滴眼液治疗原发性开角型青光眼和高眼压症的降眼压效果及安全性。方法：随机选取2013-03/2016-03我院收治的原发性开角型青光眼和高眼压症患者80例80眼,依据不同治疗方法分为两组：曲伏前列素滴眼液组( n=40)和拉坦前列素滴眼液组(n=40),对两组患者的临床疗效、视力、散光度、眼压及不良反应发生情况进行统计分析。结果：曲伏前列素滴眼液组患者治疗的总有效率95%(38/40)显著高于拉坦前列素滴眼液组80%(32/40),差异有统计学意义(P<0.05)。曲伏前列素滴眼液组患者治疗后视力显著高于拉坦前列素滴眼液组,差异有统计学意义(P<0.05),散光度、眼压均显著低于拉坦前列素滴眼液组,差异有统计学意义(P<0.05),不良反应发生率25%(10/40)显著低于拉坦前列素滴眼液组53%(21/40),差异有统计学意义(P<0.05)。结论：曲伏前列素滴眼液治疗原发性开角型青光眼和高眼压症比拉坦前列素滴眼液具有较好的降眼压效果及较高的安全性。     

选择性激光小梁成形术治疗高眼压症和不同病程原发性开角型青光眼的疗效观察

目的 对比选择性激光小梁成形术(selective laser trabeculoplasty,SLT)治疗高眼压症(ocular hypertension,OHT)和早期、中期原发性开角型青光眼(primary open-angle glaucoma,POAG)的效果.方法 根据病情将120例120眼患者分为OHT组(40例40眼)、早期POAG组(40例40眼)和中期POAG组(40例40眼),3组均使用532 nm倍频Q开关Nd:YAG激光器行SLT,激光单脉冲3 ns,光斑直径400 nm,初始能量为0.6mJ,以0.1mJ逐渐递减,至刚好出现香槟样气泡时为治疗能量,治疗范围为360°,术后1d、1周、1个月、3个月及6个月随访,主要观察SLT治疗前后的眼压变化情况.结果 治疗后1d～6个月,OHT组、早期POAG组和中期POAG组术后各个时间点的眼压均较术前下降,差异均有统计学意义(均为P＜0.05).各组内,SLT术后各时间点的眼压相比,差异亦均有统计学意义(均为P＜0.05).OHT组、早期POAG组和中期POAG患者基线眼压分别为(25.95±1.80) mmHg(1 kPa =7.5 mmHg)、(24.66±1.55) mmHg和(25.62±2.67) mmHg,差异有统计学意义(P＜0.05).当剔除基线眼压的影响之后,术后1d、1周、1个月、3个月、6个月,3组间的眼压相比差异均有统计学意义(均为P＜0.05).在各组内,术后各时间点的眼压相比,差异亦均有统计学意义(均为P＜0.05).与校正后的基线眼压相比,OHT组SLT术后眼压下降的幅度最大,其次是早期POAG组,中期POAG组下降的幅度最小.结论 SLT对于OHT和POAG患者具有良好的降眼压效果,SLT的治疗效果随POAG患者的病情严重程度逐次递减.     

Central nervous system and plasma lipid profiles associated with carteolol and timolol in postmenopausal black women

PURPOSE: Among ocular hypotensive agents, intrinsic sympathomimetic activity (ISA) is unique to carteolol hydrochloride. This study was conducted to evaluate the central nervous system (CNS) and plasma lipid profiles associated with timolol maleate and carteolol hydrochloride in postmenopausal black women with primary open-angle glaucoma (POAG) or ocular hypertension. METHODS: One hundred subjects met the inclusion and exclusion criteria for this randomized, double-masked, multicenter, parallel-group study. After completion of informed consent and complete ophthalmic examination, eligible patients entered a washout period, during which no topical ophthalmic medications were used. Blood samples were obtained for hematology and blood chemistry evaluations. Vital signs, ocular symptoms, Symptom Checklist-90-R (SCL-90-R) evaluation, intraocular pressure (IOP) measurements, and slit-lamp examinations were performed before randomization to treatment with either topical carteolol hydrochloride 1.0% or topical timolol maleate 0.5%. Patients received active medications twice daily and were monitored at 4 weeks and 12 weeks. At the conclusion of treatment, vital signs, ocular symptoms, SCL-90-R evaluation, IOP, slit-lamp examinations, and blood samples were obtained. RESULTS: Compared with baseline, high-density lipoprotein (HDL) cholesterol was significantly decreased (worsened) in the timolol group but did not change significantly in the carteolol group. The between-group difference was statistically significant. Total cholesterol to HDL ratio significantly increased (worsened) in the timolol group compared with baseline but did not change in the carteolol group. The difference between groups was statistically significant. No significant differences were observed between groups in SCL-90-R results for either somatization or depression. CONCLUSIONS: These results suggest that topical carteolol hydrochloride may have a more favorable blood lipid profile than topical timolol maleate in postmenopausal black women with POAG or ocular hypertension. Carteolol and timolol appear to have similar CNS side effect profiles.     

曲伏前列素与布林佐胺治疗开角型青光眼或高眼压症的临床研究

目的:研究曲伏前列素与布林佐胺联合治疗原发性开角型青光眼(primary open angle glaucoma,POAG)、高眼压症(ocular hypertension,OHT)及抗青光眼术后高眼压的降眼压疗效及安全性。方法:将48例52眼POAG,OHT,抗青光眼术后高眼压的患者纳入为期2mo的前瞻性、单向性、开放性研究。经药物洗脱期测量眼压基线值。用药后2,4,8,12wk测量眼压、视力、视野,观察眼部症状、体征及全身副作用。计算12wk时眼压≤17mmHg患者百分比。结果:患者基线眼压28.08±2.50mmHg,4次随访眼压(17.12±1.42,16.71±1.55,16.13±1.52,16.12±1.49)mmHg,眼压下降均值10.35mmHg,最大下降率45%。用药后眼压与基线眼压比较差值有非常显著意义(P<0.01),用药12wk时,眼压≤17mmHg的患者占64%。常见的不良反应是结膜充血,偶见轻微烧灼感,轻度味觉异常等,对角膜、泪膜、视力、视野、血压、心率均未影响。结论:曲伏前列素与布林佐胺联合应用降眼压的效果明显,安全性好。联合用药,眼压≤17mmHg患者所占百分比显著。     

The effects of prostaglandin analogues on the blood aqueous barrier and corneal thickness of phakic patients with primary open-angle glaucoma and ocular hypertension

PURPOSE: To evaluate the effects of topical latanoprost, travoprost, and bimatoprost on the blood-aqueous barrier and central corneal thickness (CCT) of patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT). DESIGN: Prospective, randomized, masked-observer, crossover clinical trial. METHODS: A total of 34 phakic patients with POAG or OHT with no previous history of intraocular surgery or uveitis completed the study. Patients were randomized to use latanoprost 0.005%, travoprost 0.004%, or bimatoprost 0.03% once daily (2000 hours) for 1 month, followed by a washout period of 4 weeks between each drug. Aqueous flare was measured with a laser flare metre. CCT was calculated as the average of five measurements using ultrasound pachymetry. All measurements were performed by a masked observer (1000 h). RESULTS: There were no statistically significant differences between baseline mean IOP, mean CCT, and mean flare values among the groups. There was no statistically significant increase in mean flare values from baseline in all groups (P>0.05). There were no statistically significant differences between mean flare values among the groups (P>0.05). All medications significantly reduced the mean IOP from baseline (P<0.0001). IOP reduction obtained with travoprost (7.3+/-3.8 mmHg) was significantly higher than that obtained with latanoprost (4.7+/-4.2 mmHg) (P=0.01). A statistically significant reduction in mean CCT (0.6+/-1.3%) from baseline was observed when patients instilled bimatoprost (P=0.01). CONCLUSIONS: Latanoprost, travoprost, and bimatoprost had no statistically significant effect on the blood-aqueous barrier of phakic patients with POAG or OHT. Bimatoprost may be associated with a clinically irrelevant reduction in mean CCT.     

The efficacy and safety of timolol maleate versus brinzolamide each given twice daily added to travoprost in patients with ocular hypertension or primary open-angle glaucoma

PURPOSE: To compare the efficacy and safety of timolol maleate 0.5% versus brinzolamide 1% when added to travoprost 0.004% in patients with ocular hypertension or primary open-angle glaucoma. DESIGN: A prospective, double-masked, randomized, active-controlled, parallel comparison. METHODS: Qualified patients at Visit 1 were placed on travoprost dosed every evening for 4 weeks and then were randomized at baseline (Visit 2) to the addition of timolol maleate or brinzolamide each given twice daily. Patients returned to clinic at Week 4 (Visit 3) for a safety visit and Week 12 (Visit 4) for an efficacy visit. At Visits 2 and 4 the intraocular pressure (IOP) was measured at 08:00, 12:00, and 16:00 hours. RESULTS: Ninety-seven patients on brinzolamide had a baseline diurnal IOP of 21.5+/-2.2 mmHg and 95 on timolol maleate had 21.3+/-2.5 mmHg, each added to travoprost. The diurnal mean IOP at Week 12 was 18.1+/-2.7 mmHg for brinzolamide and 18.1+/-3.0 mmHg for timolol maleate (p=0.96). There was no statistical difference found between treatment groups in the absolute level of pressure, or in the reduction in IOP from baseline, at each time point or for the diurnal curve (p>0.05). There was no significant difference for any adverse event between groups (p>0.05), with the most common side effect being conjunctival hyperemia in 15/97 (16%) brinzolamide and 6/95 (6%) timolol treated patients (p=0.06). CONCLUSIONS: This study showed that brinzolamide provides similar safety and efficacy compared to timolol maleate when added to travoprost.     

Effect of dorzolamide and timolol on ocular blood flow in patients with primary open angle glaucoma and ocular hypertension

BACKGROUND: There is evidence that perfusion abnormalities of the optic nerve head are involved in the pathogenesis of glaucoma. There is therefore considerable interest in the effects of topical antiglaucoma drugs on ocular blood flow. A study was undertaken to compare the ocular haemodynamic effects of dorzolamide and timolol in patients with primary open angle glaucoma (POAG) or ocular hypertension (OHT). METHODS: One hundred and forty patients with POAG or OHT were included in a controlled, randomised, double blind study in two parallel groups; 70 were randomised to receive timolol and 70 to receive dorzolamide for a period of 6 months. Subjects whose intraocular pressure (IOP) did not respond to either of the two drugs were switched to the alternative treatment after 2 weeks. Scanning laser Doppler flowmetry was used to measure blood flow in the temporal neuroretinal rim and the cup of the optic nerve head. Pulsatile choroidal blood flow was assessed using laser interferometric measurement of fundus pulsation amplitude. RESULTS: Five patients did not respond to timolol and were changed to the dorzolamide group, and 18 patients changed from dorzolamide treatment to timolol. The effects of both drugs on IOP and ocular perfusion pressure were comparable. Dorzolamide, but not timolol, increased blood flow in the temporal neuroretinal rim (8.5 (1.6)%, p<0.001 versus timolol) and the cup of the optic nerve head (13.5 (2.5)%, p<0.001 versus timolol), and fundus pulsation amplitude (8.9 (1.3)%, p<0.001 versus timolol). CONCLUSIONS: This study indicates augmented blood flow in the optic nerve head and choroid after 6 months of treatment with dorzolamide, but not with timolol. It remains to be established whether this effect can help to reduce visual field loss in patients with glaucoma.     

Effect of timolol, latanoprost, and dorzolamide on circadian IOP in glaucoma or ocular hypertension

PURPOSE: To compare the around-the-clock intraocular pressure (IOP) reduction induced by timolol 0.5%, latanoprost 0.005%, and dorzolamide in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT). METHODS: In this crossover trial, 20 patients with POAG (n = 10) or OHT (n = 10) were treated with timolol, latanoprost, and dorzolamide for 1 month. The treatment sequence was randomized. All patients underwent measurements for four 24-hour tonometric curves: at baseline and after each 1-month period of treatment. The patients were admitted to the hospital, and IOP was measured by two well-trained evaluators masked to treatment assignment. Measurements were taken at 3, 6, and 9 AM and noon and at 3, 6, and 9 PM and midnight by handheld electronic tonometer (TonoPen XL; Bio-Rad, Glendale, CA) with the patient supine and sitting, and a Goldmann applanation tonometer (Haag-Streit, Bern, Switzerland) with the patient sitting at the slit lamp. Systemic blood pressure was recorded at the same times. The between-group differences were tested for significance by means of parametric analysis of variance. The circadian IOP curve of a small group of untreated healthy young subjects was also recorded using the same procedures. To compare the circadian IOP rhythms in the POAG-OHT and control groups, the acrophases for each subject were calculated. RESULTS: When Goldmann sitting values were considered, all the drugs significantly reduced IOP in comparison with baseline at all times, except for timolol at 3 AM. Latanoprost was more effective in lowering IOP than timolol at 3, 6, and 9 AM (P = 0.03), noon (P = 0.01), 9 PM, and midnight (P = 0.05) and was more effective than dorzolamide at 9 AM, noon (P = 0.03), and 3 and 6 PM (P = 0.04). Timolol was more effective than dorzolamide at 3 PM (P = 0.05), whereas dorzolamide performed better than timolol at midnight and 3 AM (P = 0.05). An ancillary finding of this study was that in the group of healthy subjects, the pattern of IOP curve was different that in patients with eye disease. CONCLUSIONS: Latanoprost seemed to lead to a fairly uniform circadian reduction in IOP, whereas timolol seemed to be less effective during the nighttime hours. Dorzolamide was less effective than latanoprost but led to a significant reduction in nocturnal IOP. The reason for the difference in the pattern of the IOP curve of healthy subjects is currently unknown and deserves further investigation.