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。

The efficacy and safety of Tafluprost as a therapy for patients with primary open angle glaucoma

Objective　To evaluate the efficacy of Tafluprost for intraocular pressure (IOP) in patients with primary open angle glaucoma.Methods　This study included 66 adult patients with 116 eyes who were diagnosed as primary open-angle glaucoma（POAG）.These patients were grouped into first choice group with 36 eyes in 18 patients,the combination group with 38 eyes in 26 patients and the alternative treatmetn group with 42 eyes in 22 patients.All the patients were treated with Tafluprost 0.0015% once every night.The IOP measurements by Goldmannapplanation tonometer,the visual acuity,slit lamp microscope examination,corneal fluorescein test and fundus examination were conducted before treatment,4 weeks and 12 weeks after treatment.IOP measurements were performed at 8-9 AM at the follow-up visits.The vision field was tested before treatment and 12 weeks after the medication.All results documented and statistical analyzed.Results　For patients in first choice group of Tafluprost,the mean IOP was (24.6±3.6)mmHg (1 kPa=7.5 mmHg) before treatment,and after treatment for 4 weeks and 12 weeks,the mean IOP was (18.8±1.5)mmHg and (18.6±1.7)mmHg,respectively,and the decrease of IOP was (5.7±2.1)mmHg and (6.1±2.3)mmHg,respectively.By compared with before treatment,the difference was statistically significant (t=14.365,17.238;P<0.001).The IOP was significantly decreased.In the combination group,the average IOP was (25.7±5.7)mmHg before treatment,and after 4 weeks and 12 weeks of treatment,the average IOP was (18.7±3.4)mmHg and (17.4±3.2)mmHg,respectively,and the average decrease of IOP was (6.6±3.5)mmHg,(6.8±3.7)mmHg after treatment,respectively.Compared with before treatment,the difference was statistically significant (t=12.84,13.365;all P<0.001).In the alternative treatment group,the average IOP was (22.8±5.6)mmHg,(17.1±3.2)mmHg and (16.2±2.6)mmHg for before treatment,4 weeks and 12 weeks after treatment,respectively,and the average decrease of IOP was (5.6±3.8)mmHg and (6.6±4.2)mmHg for 4 weeks and 12 weeks of medication,respectively.In the replacement of beta receptor blocking agent,the decrease of IOP was about (5.0±4.1)mmHg，(6.3±4.1)mmHg after 4 weeks and 12 weeks of treatment respectively.While replacement of prostaglandin analogs,the decrease of IOP was about (5.8±2.5)mmHg,(6.4±4.7)mmHg after 4 weeks and 12 weeks of treatment,respectively.Compared with before treatment,the difference was significant (t=12.095,13.07;all P<0.001),the IOP was significantly decreased both 4 weeks and 12 weeks after treatment.In terms of side effects,only seven patients were reported with the mild to moderate hyperemia of conjunctiva and no fluorescein staining was detected in the cornea.The mean defect（MD） in visual field before treatment was（5.4±1.8）dB,and (5.6±1.4)dB after treatment,which showed no statistically significant (P>0.05).Conclusion　Tafluprostcould significantly reduce the IOP,and the potential benefits of Tafluprost as a first choice or a combination or a alternative agent can achieve for adequate IOP control in POAG patients.