高度近视性黄斑裂孔玻璃体切割术后早期高眼压的药物治疗

目的：通过观察高度近视性黄斑裂孔不伴视网膜脱离患者行玻璃体切割术后早期发生高眼压应用降压药物的疗效,以明确单独或联合应用拉坦前列素滴眼液的降压效果。

方法：于我院行23G玻切联合C₃F₈注入的高度近视性黄斑裂孔不伴视网膜脱离患者188例205眼; 监测术后1wk内的眼压。当眼压介于22～29mmHg时设为A组,随机加用盐酸卡替洛尔滴眼液(A1组)或拉坦前列素滴眼液(A2组); 当介于30～39mmHg时设为B组,随机加用盐酸卡替洛尔滴眼液+酒石酸溴莫尼定滴眼液(B1组)或盐酸卡替洛尔滴眼液+拉坦前列腺素滴眼液(B2组); 当高及40mmHg及以上时,设为C组,20%甘露醇快速静脉滴注1次,并随机加用盐酸卡替洛尔滴眼液+酒石酸溴莫尼定滴眼液+布林佐胺滴眼液(C1组)或盐酸卡替洛尔滴眼液+酒石酸溴莫尼定滴眼液+拉坦前列腺素滴眼液(C2组)。连续观察3d,眼压降至21mmHg及以下时则视为有效,比较不同用药3d内的降压有效率、降压幅度及平均有效作用时间。

结果：符合研究标准的术后高眼压共89眼,发生于前3d共70眼(78.6%)。A组共31眼,A1组14眼,A2组17眼; 有效例数分别为5例(35.7%)、13例(76.5%),差异有统计学意义(χ²=5.24,P=0.03); 降压幅度分别为4.21±1.22mmHg(24%)、8.76±3.03mmHg(29.6%),差异有统计学意义(t=5.73,P<0.05); 平均有效作用时间分别为2.80±0.45、2.08±0.49d,差异有统计学意义(t=2.85,P=0.012)。B组共32眼,B1组17眼,B2组15眼,有效例数分别为9例(52.9%)、11例(73.3%),差异无统计学意义(χ²=1.40,P=0.30); 降压幅度分别为10.59±2.72mmHg(36.9%)、16.53±2.67mmHg(43.8%),差异有统计学意义(t=6.27,P<0.05); 平均有效作用时间分别为2.56±0.53、1.63±0.67d,差异有统计学意义(t=3.34,P=0.004)。C组共26眼,C1组14眼,C2组12眼,有效例数分别为9例(64.3%)、8例(66. 7%),差异无统计学意义(P=0.70); 降压幅度分别为22.00mmHg(51.0%)、31.45mmHg(59.3%),差异有统计学意义(t=18.35,P<0.05); 平均有效作用时间分别为2.63±0.52、1.80±0.63d,差异有统计学意义(t=2.97,P=0.009)。

结论：高度近视性黄斑裂孔玻璃体切割术后伴发高眼压的比率较高,一般发生在术后3d内,单独或联合应用拉坦前列素滴眼液可以有效降低眼压。     

拉坦前列腺素对原发性开角型青光眼患者的疗效

目的:研究拉坦前列腺素对原发性开角型青光眼(POAG)患者的治疗效果.方法:POAG患者135例,随机分为观察组(n=70)和对照组(n=65),观察组给予拉坦前列腺素治疗,对照组给予噻吗心安治疗;记录2组患者治疗前后的眼压及波动值、视野缺损及视网膜纤维层(RNFL)厚度及不良反应.结果:两组患者治疗后昼夜平均眼压、眼压波动值及视野缺损范围均较治疗前明显降低,差异有统计学意义(P＜0.05);治疗后观察组昼夜平均眼压、眼压波动值较对照组降低更明显,下方视野、颞侧视野及鼻侧视野缺损范围较对照组明显缩小,上方视盘、下方视盘、颞侧视盘及鼻侧视盘较对照组明显增厚,差异均有统计学意义(P＜0.05);治疗后观察组9例(12.86％)、对照组11例(16.92％)出现不良反应,差异无统计学意义(P＞0.05).结论:拉坦前列腺素治疗原发性开角型青光眼效果优于噻吗心安.     

Quantitative analysis of eyelash lengthening following topical latanoprost therapy

BACKGROUND: There have been several reports, mostly qualitative, of ocular side effects of latanoprost, including lengthening of eyelashes. We investigated changes in eyelash length in patients receiving topically administered latanoprost. METHODS: Seventeen patients (11 men and 6 women aged 63 to 80 years) with glaucoma or ocular hypertension were treated with latanoprost (one drop to one eye daily at bedtime). All had dark brown irises. At the start of treatment and after 2, 6 and 10 weeks of treatment, a single eyelash was removed from the centre of the upper eyelid of the treated and fellow (control) eyes and measured. Adverse events (defined as any undesirable event occurring in a subject, regardless of whether it was considered related to the latanoprost treatment) were monitored carefully. At each examination patients were asked whether they had any ocular or systemic symptoms. RESULTS: For the eyes treated with latanoprost, the mean eyelash length (and standard deviation) was 5.8 mm (0.7 mm) at baseline, 6.5 mm (0.6 mm) at 2 weeks, 6.5 mm (0.9 mm) at 6 weeks and 6.6 mm (0.7 mm) at 10 weeks (p < 0.001 for all differences from baseline). The corresponding values for the untreated eyes were 5.7 mm (0.7 mm), 5.8 mm (0.7 mm), 5.9 mm (0.7 mm) and 5.6 mm (0.7 mm); all differences were nonsignificant. INTERPRETATION: Latanoprost significantly increases eyelash length.     

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。     

Short-term effect of latanoprost on ocular circulation in ocular hypertension

PURPOSE: To determine the short-term effects of latanoprost on retrobulbar circulation in ocular hypertension. METHODS: Forty-six eyes of 23 consecutive bilateral ocular hypertensive patients with an intraocular pressure (IOP) of greater than 22 mmHg were evaluated in a prospective controlled study. All subjects received a single drop of latanoprost 0.005% in one eye and placebo in the fellow control eye. Systemic circulatory parameters, intraocular pressure, blood flow velocities, and resistance indices of the ophthalmic, short posterior ciliary and central retinal arteries were measured using colour Doppler imaging at baseline and 2 h and 8 h after dosing. RESULTS: Latanoprost lowered IOP significantly after 2 h and 8 h (P < 0.01). The mean IOP reduction was 6.7 mmHg 8 h after dosing. At baseline, there were no statistically significant differences in any retrobulbar vessels of eyes that received a single drop of latanoprost when compared with the eyes that received placebo (P > 0.05). Comparisons with baseline and latanoprost conditions revealed that latanoprost did not alter the blood flow velocities and resistance indices in the ophthalmic (P > 0.05), posterior ciliary (P > 0.05) and central retinal (P > 0.05) arteries 2 h and 8 h after dosing. The systolic and diastolic blood pressures (p = 0.74, p = 0.29, respectively) and pulse rate (p = 0.68) remained unchanged over the 8-h period. CONCLUSIONS: This study found that a single drop of latanoprost significantly reduces intraocular pressure 8 h after dosing. However, it does not have any short-term effects on the retrobulbar haemodynamics in ocular hypertensive eyes.     

Studies on ocular inflammation and development of a prostaglandin analogue for glaucoma treatment

This review summarizes the Ernst H. Bárány Prize Lecture given at the meeting of the International Society of Eye Research in Geneva 2002. In the paper the path from the author's early studies on neurogenic inflammation in the eye to the search for a suitable prostaglandin analogue for glaucoma treatment, and the development of latanoprost are described. In particular the solution to the nociceptive and hyperemic side-effects of naturally occurring prostaglandins in the eye, the mechanism of action of FP prostanoid receptor agonists as well as the selection of dose for glaucoma treatment are discussed. In addition, pharmacokinetical aspects of latanoprost, and the melanogenic side-effect of prostaglandins in the iris are addressed. The paper is primarily focused on studies performed by the author and complete reference to other previous, or contemporary studies is therefore not always given as the purpose is not to present a comprehensive review article.     

A Prospective Study of Iridial Pigmentation and Eyelash Changes Due to Ophthalmic Treatment with Latanoprost

Purpose To conduct a 12-month prospective study on the occurrence of latanoprost-induced iridial pigmentation and eyelash change in Japanese patients with glaucoma.Methods Seventy-five patients (75 eyes) were enrolled in the study. Photographs of the iris and eyelashes were taken under identical conditions before and after treatment. Three glaucoma specialists assessed the iridial pigmentation/eyelash change independently with no knowledge of patient data. The effects of age, sex, concomitant medication, and type of glaucoma on iridial pigmentation/eyelash change were investigated, and intraocular pressure (IOP) reduction and iridocorneal angle pigmentation before and after latanoprost treatment were compared between patients with iridial pigmentation/eyelash change and patients without these changes.Results The incidence of iridial pigmentation was 6.3% at 1 month, 15.7% at 3 months, 37.8% at 6 months, and 56.5% at 12 months. The incidence of eyelash change was 0% at 1 month, 33.8% at 3 months, 44.4% at 6 months, and 46.2% at 12 months. Latanoprost did not affect IOP reduction or iridocorneal angle pigmentation. No significant relationship between iridial pigmentation and eyelash change was observed. None of the investigated parameters except age affected the iridial pigmentation/eyelash change.Conclusion Iridial pigmentation and eyelash change occurred at a high frequency in long-term treatment with latanoprost in Japanese glaucoma patients. Jpn J Ophthalmol 2004;48:141–147 © Japanese Ophthalmological Society 2004     

Switch to Latanoprost Monotherapy from Combined Treatment with β-Antagonist and Other Antiglaucoma Agents in Patients with Glaucoma or Ocular Hypertension

Purpose To investigate the effects on intraocular pressure (IOP) and the occurrence of adverse events upon switching directly to latanoprost monotherapy from multiple drug therapy, including a -antagonist, for glaucomatous eyes.Methods Patients with primary open-angle glaucoma or ocular hypertension and receiving long-term therapy with two or three topical ocular hypotensive drugs (including one topical -antagonist) were switched to latanoprost monotherapy for 12 weeks without any intervening washout period. Observations were performed before switching (baseline) and at weeks 4, 8, and 12 after switching to latanoprost monotherapy.Results Of the 29 enrolled patients, 26 (90%) completed this protocol. Three patients had excessive IOP elevation, and these patients were withdrawn. The switch to latanoprost monotherapy was followed by a significant (P < 0.0001) mean reduction of 3.9mmHg at week 12 in per-protocol cases (n = 26) and a significant (P = 0.0016) mean reduction of 2.8mmHg at last postswitch visit in patients in the intent-to-treat analysis group (n = 29). Adverse ocular events other than IOP elevation were mild.Conclusions The switch to latanoprost monotherapy in glaucoma patients receiving multiple drug therapy resulted in an additional, significant IOP reduction. Jpn J Ophthalmol 2004;48:276–280 © Japanese Ophthalmological Society 2004     

Efficacy and safety of tafluprost 0.0015% versus latanoprost 0.005% eye drops in open‐angle glaucoma and ocular hypertension: 24‐month results of a randomized,double‐masked phase III study

Purpose: The objective of the study was to compare the long‐term efficacy and safety of tafluprost 0.0015% with latanoprost 0.005% eye drops in patients with open‐angle glaucoma or ocular hypertension. Methods: This double‐masked, active‐controlled, parallel‐group, multinational, multicentre, phase III study was conducted at 49 centres in 8 countries. Eligible patients were assigned to treatment administered once daily at 20:00 hrs for up to 24 months. Change from baseline intraocular pressure (IOP) was the primary efficacy variable. Adverse events were recorded and ocular safety was evaluated. Both tafluprost and latanoprost were preserved with benzalkonium chloride. Results: From 533 patients randomized, 402 patients completed 24 months of therapy. Both treatments had a substantial IOP‐lowering effect which persisted throughout the study (?7.1 mmHg for tafluprost and ?7.7 mmHg for latanoprost at 24 months). Although the IOP‐lowering effect during the study was slightly larger with latanoprost, this difference was clinically small and the noninferiority of tafluprost to latanoprost over all diurnal IOP measurements was shown with anova and almost reached with ancova (upper limits of the 95% confidence intervals 1.38 and 1.52 for the overall period, respectively). The noninferiority limit was 1.5 mmHg. Conclusions: Tafluprost is a new effective and well‐tolerated treatment for glaucoma and ocular hypertension.