三种前列腺素类滴眼液治疗原发性开角型青光眼的降眼压效果比较

目的 比较拉坦前列素、曲伏前列素及贝美前列素3种前列腺素类滴眼液治疗原发性开角型青光眼患者4周后的24h降眼压效果。方法 病例对照研究。选取2009年1月至6月门诊就诊的原发性开角型青光眼患者63例（63只眼）。其中拉坦前列素组21例（21只眼）,曲伏前列素组22例（22只眼）,贝美前列素组20例（20只眼）,分别使用相应的滴眼液,均为每日滴药1次,共观察4周,测量用药前后的24h眼压曲线。3组间用药前或用药后24h不同时间点眼压值比较采用两因素重复测量的方差分析,眼压波动幅度比较采用单因素方差分析。结果 3组患者用药4周后眼压均明显下降,拉坦前列素组眼压从(18.9±2.1)mm Hg（1mm Hg =0.133 kPa）降至(15.3±2.7)mm Hg,下降幅度（用药前后眼压差值/用药前眼压值）为19.0％;曲伏前列素组眼压从(19.1±3.1)mm Hg降至(15.3 ±2.1)mm Hg,下降幅度为19.4％;贝美前列素组眼压从(18.6±1.9) mm Hg降至(14.9±1.9)mm Hg,下降幅度为19.9％。波幅下降幅度（用药前后波幅差值/用药前波幅值）,拉坦前列素组为31.0％,曲伏前列素组为31.1％,贝美前列素组为31.9％。用药前及用药后3组间眼压值随时间点变化差异均无统计学意义(F= 1.501,P=0.110),3组间用药后眼压波幅下降幅度差异无统计学意义(F =0.286,P=0.752)。结论 拉坦前列素、曲伏前列素、贝美前列素3种滴眼液对原发性开角型青光眼的昼夜降眼压效果显著且无明显差别。     

三种前列腺素类药物降眼压效果比较

目的比较拉坦前列素、曲伏前列素和贝美前列素三种前列腺素类药物的降眼压效果。方法选取原发性开角型青光眼和高眼压症患者,拉坦前列素组51例(51眼),曲伏前列素组24例(24眼),贝美前列素组27例(27眼),分别使用相应滴眼液,均为每日1次,共观察4周,测量用药前后的眼压值。结果三组患者用药4周后眼压均有明显下降,拉坦前列素组在8:30测得平均眼压从(24.57±3.68)mmHg(1 mmHg=0.133 kPa)降至(15.29±2.67)mmHg,下降幅度(用药前后眼压差值/用药前眼压值)为37.8%;曲伏前列素组从(24.54±2.95)mmHg降至(16.29±3.11)mmHg,下降幅度为33.6%;贝美前列素组从(25.41±3.63)mmHg降至(16.00±4.45)mmHg,下降幅度为37.0%。用药前及用药后三组间眼压值比较,差异均无显著性(分别为F=0.579、P=0.562;F=0.868、P=0.423)。结论拉坦前列素、曲伏前列素、贝美前列素滴眼液对于原发性开角型青光眼和高眼压症患者都有明显、持久的降眼压作用,且降眼压作用相互间没有明显差异。     

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。     

国产拉坦前列素滴眼液对POAG和高眼压症的降眼压疗效及安全性多中心研究

背景 拟前列腺素滴眼液是治疗青光眼,尤其是开角型青光眼的一线药物,但价格较高.国产的类似药物拉坦前列素滴眼液已应用于临床,但大样本、多中心的疗效和安全性评价鲜有报道. 目的 采用多中心观察性研究方法评价国产拉坦前列素滴眼液治疗原发性开角型青光眼（POAG）和高眼压症的临床疗效及安全性.方法 采用多中心观察性研究方法,按照统一的纳入标准和排除标准在中国5个地区25家医院纳入确诊的POAG及高眼压症患者576例837眼,其中POAG患者524例755眼,高眼压症患者52例82眼.本研究经广州军区武汉总医院伦理委员会批准实施,所有患者均知情同意并签署知情同意书.患者每晚用0.05 g/L国产拉坦前列素滴眼液点眼1次,用药3个月,主要观察指标为眼压控制情况,次要观察指标为视力、血压、脉搏、眼部症状和体征,采用用药前后自身对照的方法评价药物的疗效及安全性.结果 患者用药后1、2、3个月的眼压分别为（19.66±5.46）、（19.59±7.86）和（19.35±5.03）mmHg（1 mmHg=0.133 kPa）,均较用药前的（28.36±7.86） mmHg明显下降,各时间点眼压值的总体差异有统计学意义（F=748.325,P=0.000）,其中治疗后各时间点的眼压值均明显低于治疗前,差异均有统计学意义（P＜0.001）;用药后1、2、3个月眼压的平均下降幅度分别为（30.43±7.18）％、（30.19±8.72）％和（30.71±9.90）％.治疗后1、2、3个月显效率分别为95.70％、91.76％和88.05％.用药后3个月出现结膜持续充血者占13％,但不妨碍继续用药,未发现与药物相关的全身及其他眼部不良反应.结论 国产拉坦前列素滴眼液可有效降低眼压,安全性好,为治疗开角型青光眼及高眼压症提供了新的选择.     

新型抗青光眼药物——卢美根

近年来，新型降眼压药物不断出现，目前拟前列腺素类药物以其良好的降眼压效果和卓越的安全性而越来越受到患者的欢迎。目前国内已上市的拟前列腺素类药物包括：拉坦前列素（Latanoprost）、曲伏前列素（Travoprost）和贝美前列素（Bimatoprost）。     

O.03%贝美前列素滴眼液与0.005%拉坦前列素滴眼液的降眼压效果和安全性比较

目的比较0.03%贝美前列素滴眼液与0.005%拉坦前列素滴眼液降眼压治疗的有效性和安全性.方法随机、研究者设盲、平行对照临床试验.56例原发性开角型青光眼或高眼压症患者,随机分配接受0.03%贝美前列素和0.005%拉坦前列素治疗,观察治疗42天后降眼压效果及不良反应.结果 0.03%贝美前列素和0.005%拉坦前列素均能显著降低眼内压(P＜0.001).6周治疗后,贝美前列素和拉坦前列素降低眼压分别为5.92～9.18mmHg(26.3%～36.1%)和7.25～9.85mmHg(31.3%～38.9%),两者之间差异无统计学意义.贝美前列素和拉坦前列素均有较好的安全性,最常见的不良反应为结膜充血.结论 0.03%贝美前列素滴眼液和0.005%拉坦前列素滴眼液均能显著降低国人开角型青光眼和高眼压症患者的眼压,而且安全、有较好的耐受性.两者差异无统计学意义.     

局部应用前列腺素类药物对中央角膜厚度改变的影响

目的:分析曲伏前列素、拉坦前列素和贝美前列素用药后对中央角膜厚度的影响。方法:采用回顾性临床病例对照研究,60例68眼随机分为3组,其中曲伏前列素组20例22眼,拉坦前列素组20例25眼,贝美前列素组20例21眼。测量用药前及用药6mo后的中央角膜厚度。结果:三组用药后平均中央角膜厚度与用药前比较均明显变薄,曲伏前列素组从525±36.45μm下降至510±27.87μm(t=8.11,P<0.05),拉坦前列素组从530±26.65μm下降至512±22.27μm(t=5.62,P<0.05),贝美前列素组从534±47.35μm下降至516±19.56μm(t=5.62,P<0.05)。用药后6mo,三组间平均中央角膜厚度比较无明显差别(F=0.205,P=0.544)。结论:局部应用前列腺素类药物可以使中央角膜厚度变薄。     

他氟前列素治疗开角型青光眼的疗效观察

目的　探讨他氟前列素滴眼液对初始用药、单药或多种药物降压控制不佳的开角型青光眼患者的降眼压疗效。方法　将66例116眼诊断为原发性开角型青光眼患者纳入本研究,分为首选治疗组18例36眼、联合用药组26例38眼和替换治疗组22例42眼。每晚使用他氟前列素滴眼液1次,每次一滴。在治疗前以及治疗后4周和12周进行Goldmann压平眼压计测量眼压,测量时间均为早上8-9点;进行视力、裂隙灯下眼前段检查、角膜荧光素染色及眼底镜检查;在用药前与治疗后12周行Humphery视野检查,记录各组结果并进行相关统计学分析。结果　首选治疗组治疗前眼压为（24.6±3.6）mmHg（1 kPa=7.5 mmHg）;治疗后4周和12周眼压分别为（18.8±1.5）mmHg、（18.6±1.7）mmHg,分别下降（5.7±2.1）mmHg、（6.1±2.3）mmHg,与治疗前比较,差异均有统计学意义（t=14.365、17.238;均为P＜0.001）。联合用药组治疗前眼压为（25.7±5.7）mmHg;治疗后4周和12周眼压分别为（18.7±3.4）mmHg和（17.4±3.2）mmHg,分别下降（6.6±3.5）mmHg、（6.8±3.7）mmHg,与治疗前比较,差异均有统计学意义（t=12.840、13.365;均为P＜0.001）。替换治疗组治疗前眼压为（22.8±5.6）mmHg;治疗后4周和12周眼压分别为（17.1±3.2）mmHg、（16.2±2.6）mmHg,分别下降（5.6±3.8） mmHg、（6.6±4.2）mmHg;其中替换β受体阻滞剂与前裂腺素类药物降压治疗,治疗后4周与12周眼压下降幅度在替换β阻滞剂组（5.0±4.1）mmHg、（6.3±4.1） mmHg,在替换PG类药物组为（5.8±2.5）mmHg、（6.4±4.7）mmHg,治疗后12周同治疗前比较,差异均有统计学意义（t=12.095、13.070;均为P＜0.001）。共有7眼患者出现不良反应,为轻到中度结膜充血,未见角膜染色。治疗前视野缺损为（5.4±1.8）dB,治疗后12周为（5.6±1.4）dB,治疗前后差异无统计学意义（P>0.05）。结论　他氟前列素滴眼液能有效降低原发性开角型青光眼患者的眼压;对首选用药、替代治疗及联合用药,他氟前列素滴眼液均能有效控制眼压。     

噻吗洛尔或卡替洛尔联合曲伏前列素的降眼压作用及对心血管系统的影响

目的比较噻吗洛尔与卡替洛尔分别联合曲伏前列素对原发性开角型青光眼（POAG）或高眼压症（OHT）患者的降眼压作用及对心血管系统的影响。方法随机双盲对照试验。将纳入的162例患者随机分为噻吗洛尔组和卡替洛尔组,噻吗洛尔组患者使用噻吗洛尔滴眼液联合曲伏前列素滴眼液点眼;卡替洛尔组患者使用卡替洛尔滴眼液联合曲伏前列素滴眼液点眼。在患者治疗后第14天、28天进行疗效评价及心血管不良反应、其他药物不良反应评价。采用重复测量资料的方差分析对数据进行比较。结果2组患者治疗前人口基线特征差异均无统计学意义。2组患者用药后14、28 d与治疗前比较,眼压均下降（P＜0.05）,组间差异无统计学意义。用药后28 d,2组心率均下降（P＜0.05）,噻吗洛尔组较卡替洛尔组的心率抑制作用明显（P＜0.05）;22∶00-04∶00时间段内患者心率与治疗前相比差异具有统计学意义（P＜0.05）;噻吗洛尔组心率过缓发生率增加,而卡替洛尔组下降,00∶00-04∶00时间段内卡替洛尔组心动过缓的发生率低于噻吗洛尔组（χ²=4.077,P＜0.05）。治疗后收缩压、舒张压均下降,治疗前后差异有统计学意义（P＜0.05）,组间差异无统计学意义。结论对于POAG或OHT患者,噻吗洛尔或卡替洛尔联合曲伏前列素均具有较好的降眼压效果。在22∶00以后,卡替洛尔联合曲伏前列素引起心动过缓和心率下降的比率较低。     

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。     

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.     

24-h IOP control with latanoprost, travoprost, and bimatoprost in subjects with exfoliation syndrome and ocular hypertension

PURPOSE: To compare the 24-h IOP reductions induced by latanoprost, travoprost, and bimatoprost in eyes with exfoliation syndrome (XFS) associated with ocular hypertension (OH). METHODS: This was a prospective, randomized, single masked, and parallel design study with 15 patients in each treatment group. After washout of any previous medications, each patient underwent a baseline 24-h IOP curve testing at 0600, 0900, 1200, 1500, 1800, 2100, and at 2400 (midnight) hours. Patients were then randomized to receive latanoprost, travoprost, or bimatoprost once a day for 3 months. The 24-h curve testing was repeated at first week, and first and third months. RESULTS: Maximal and minimal IOP was recorded at 0600 and 1800-2100 hours. There was no significant difference among treatment groups at any time-point except for the first week. At the first week, the travoprost group had significantly lower IOP levels than the latanoprost and bimatoprost groups. All medicines significantly lowered 24-h IOP from baseline (P=0.001 for each). Although there was no significant difference in IOP reduction among groups at first week and first month, bimatoprost reduced the 24-h IOP (7.9+/-1.4) more than travoprost (6.6+/-0.5) at the end of the third month (P=0.003). The mean 24-h range of IOP was lowest with travoprost in all visits, and between-group differences was significant for travoprost vslatanoprost (P=0.007) and travoprost vsbimatoprost (P=0.001) at the third month. CONCLUSION: Latanoprost, travoprost, and bimatoprost were effective in reducing the 24-h IOP in patients with XFS and OH, and more research is required with a larger study.     

Comparing the Efficacy of Latanoprost (0.005%), Bimatoprost (0.03%), Travoprost (0.004%), and Timolol (0.5%) in the Treatment of Primary Open Angle Glaucoma

Purpose

To compare the efficacy and safety of latanoprost, bimatoprost, travoprost and timolol in reducing intraocular pressure (IOP) in patients with primary open angle glaucoma.

Methods

This was a prospective study conducted at a tertiary-care centre. One hundred and forty patients with newly diagnosed primary open angle glaucoma were randomly assigned to treatment with latanoprost (0.005%), bimatoprost (0.03%), travoprost (0.004%) or timolol gel (0.5%); 35 patients were assigned to each group. All patients were followed for 2, 6, and 12 weeks. The main outcome measure studied was the change in IOP at week 12 from the baseline values. Safety measures included recording of adverse events.

Results

The mean IOP reduction from baseline at week 12 was significantly more with bimatoprost (8.8 mmHg, 35.9%) than with latanoprost (7.3 mmHg, 29.9%), travoprost (7.6 mmHg, 30.8%) or timolol (6.7 mmHg, 26.6%) (ANOVA and Student''s t-tests, p < 0.001). Among the prostaglandins studied, bimatoprost produced a maximum reduction in IOP (-2.71; 95% confidence interval [CI], -2.25 to -3.18) followed by travoprost (-1.27; 95% CI, -0.81 to -1.27) and latanoprost (-1.25; 95% CI, -0.79 to -1.71); these values were significant when compared to timolol at week 12 (Bonferroni test, p < 0.001). Latanoprost and travoprost were comparable in their ability to reduce IOP at each patient visit. Ocular adverse-events were found in almost equal proportion in patients treated with bimatoprost (41.3%) and travoprost (41.9%), with a higher incidence of conjunctival hyperemia (24.1%) seen in the bimatoprost group. Timolol produced a significant drop in heart rate (p < 0.001) at week 12 when compared to the baseline measurements.

Conclusions

Bimatoprost showed greater efficacy when compared to the other prostaglandins, and timolol was the most efficacious at lowering the IOP. Conjunctional hyperemia was mainly seen with bimatoprost. However, the drug was tolerated well and found to be safe.     

Comparison of efficacy of four prostaglandin analogues by bilateral treatment in healthy subjects

Purpose

To compare the drug efficacy of four prostaglandin analogues (PGAs) by bilateral treatment in normal subjects.

Methods

Three consecutive studies comparing latanoprost to three other PGAs (travoprost, tafluprost and bimatoprost) were performed in 24 healthy subjects. Each study was separated by a washout period of over 6?weeks. In each study, two drugs were randomly assigned to one eye of each subject. Study subjects instilled the assigned medication at 9:00?p.m. every day for 2?weeks. The same masked investigator measured intraocular pressure (IOP) at 9:00?a.m., 1:00?p.m. and 5:00?p.m. at baseline and repeated measurements on days 7 and 14. The differences in IOP reduction were compared between the drugs.

Results

Mean diurnal IOP reduction with latanoprost on days 7 and 14 was similar to that with travoprost and tafluprost, but was significantly lower than that with bimatoprost. The association of the mean diurnal IOP reduction between latanoprost and bimatoprost on day 14 (r ²?=?0.25) was weak, in remarkable contrast to the strong association between latanoprost and travoprost (r ²?=?0.81) and between latanoprost and tafluprost (0.82).

Conclusions

The short-term bilateral treatment revealed a different IOP-lowering efficacy of bimatoprost compared to other PGAs in healthy subjects.     

Prostaglandin analogs and blood-aqueous barrier integrity: a flare cell meter study

PURPOSE: To study, with an objective method, inflammation of the anterior segment of the glaucomatous eye after treatment with latanoprost, travoprost and bimatoprost. MATERIALS AND METHODS: Sixty patients with chronic open-angle glaucoma aged between 38 and 76 years (mean 64.0 +/- 12.2) were randomly assigned to latanoprost 0.005, travoprost 0.004 and bimatoprost 0.03%. The study period lasted 6 months. Intraocular pressure (IOP) was measured every 2 weeks. We studied the intraocular inflammation before and after 3 and 6 months of therapy with an instrument composed of a He-Ne laser beam system, a photomultiplier mounted on a slitlamp microscope and a computer. This flare meter allows objective determination of the flare and the number of cells in the aqueous of the anterior chamber. RESULTS: At the baseline, IOP was 26.4 +/- 3.6 mm Hg. After 3 months of treatment, mean IOP in the latanoprost group was 17.9 +/- 0.3 mm Hg (p < 0.001) with a mean cellularity of 12.638 +/- 3.284 photons/ms (p < 0.001). The travoprost group had an IOP of 17.2 +/- 0.3 mm Hg (p < 0.001) with a cellularity of 9.719 +/- 1.927 photons/ms (0.001). Finally, IOP in the bimatoprost group was 17.6 +/- 0.5 mm Hg (p < 0.001) with a cellularity of 6.138 +/- 1.475 photons/ms (p < 0.032). After 6 months of treatment, IOP in the latanoprost group was 18.1 +/- 0.3 (p < 0.001), in the travoprost group 17.3 +/- 0.3 (p < 0.001) and in the bimatoprost group 17.7 +/- 0.5 mm Hg (p < 0.001), whereas cellularity was 11.838 +/- 3.218 (p < 0.001), 8.950 +/- 3.692 (p < 0.001) and 7.617 +/- 2.603 photons/ms (p < 0.001), respectively. After 3 months, the travoprost (p < 0.013) and the bimatoprost groups (p < 0.001) had less flare compared with the latanoprost group and this remained so even at 6 months. When we compared the travoprost group with the bimatoprost group, we found significantly less flare at 3 months in the bimatoprost group (p < 0.001) but not at 6 months (p < 0.246). CONCLUSIONS: The flare meter analysis shows that the eyes treated with bimatoprost and travoprost have a less significantly broken blood-aqueous barrier and their anterior chamber is also significantly less inflamed.     

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.     

Water-drinking test in patients with primary open-angle glaucoma while treated with different topical medications.

OBJECTIVE: Reduction and diurnal stabilization of the intra-ocular pressure (IOP) is the mainstay of treatment for glaucoma. Fluctuations of IOP in glaucomatous patients can also be induced by the osmotic variations caused by water ingestion. Such influence can be studied by means of the water-drinking test (WDT). The aim of this study was to perform the WDT in patients with primary open-angle glaucoma (POAG) while they were being treated with different IOP-lowering medications, to test the effect of drugs with different mechanisms of action on the ability to maintain a stable IOP. METHODS: A total of 280 POAG patients were enrolled, 40 patients per group for each of the tested medications (timolol, dorzolamide, brinzolamide, travoprost,latanoprost, bimatoprost, and brimonidine). After baseline IOP measurement, all patients underwent WDT (1000 mL of water in 10 min). The IOP was measured at 15-min intervals until the return of IOP to baseline values. The main outcomes measured were mean IOP peak, mean IOP percentage increase, and mean time for returning to baseline IOP value. RESULTS: The highest mean IOP peak was found with timolol, whereas no difference was found among the other drugs. The highest mean IOP percentage increase was found with timolol, whereas bimatoprost showed an IOP percentage increase significantly lower than latanoprost, dorzolamide, and brinzolamide. The duration of IOP increase was shortest for bimatoprost and longest for timolol. CONCLUSION: This study suggests that topical medications that enhance outflow (e.g., bimatoprost, latanoprost, travoprost, and brimonidine) may provide, under stressful conditions such as the WDT, better IOP stabilization than medications that decrease aqueous humor inflow, such as timolol and topical carbonic anhydrase inhibitors.