重视长期局部应用抗青光眼药物对眼表组织的损伤

Challenge and treatment strategy for ocular surface damage in patients with long term use ofantiglaucoma drugs

长期应用抗青光眼药物能引起结膜慢性炎症、浅层点状角膜炎及干眼症等眼表疾病。病理研究发现该类患者结膜杯状细胞数量减少、眼表上皮鳞状化生及角膜上皮细胞凋亡。已有证据表明滴眼液中的防腐剂苯扎氯胺有毒性作用，是眼表组织损伤的重要原因。药物性眼表损伤患者临床表现无特异性，症状轻微，病变发生滞后，常与眼表疾病共存或混淆，可严重影响患者的生活质量和青光眼的治疗。因此，要十分重视长期局部应用抗青光眼药物对眼表组织的损伤问题，选用降眼压效果好、作用时间长的抗青光眼药物，必要时使用联合固定配方制剂，减少药物使用的种类和次数。对需要使用多种药物才能达到靶眼压或出现眼表组织损伤的患者，应及时采取手术或激光等其他治疗措施。注意对眼表组织损伤的预防及共存眼表疾病的治疗。研制无防腐剂或含有新型防腐剂的抗青光眼药物，改进或研制长效药物和药物赋形剂是今后新型抗青光眼药物剂型发展的方向。f中华瞑科杂志。2011，47：101-104）

Long term use of topical anti-glaucoma drugs has been shown to induce chronic conjunctivitis, superficial punctate keratitis （SPK） and dry eye symptom. Under these conditions, a loss of goblet cells in conjunctiva, epithelial squamous metaplasia and apoptosis were morphologically revealed. Benzalkonium Chloride （ BKC）, a most frequently used preservative in eye drops, has been found to be an important factor causing ocular surface damage. Furthermore, a big challenge for ophthalmologists is that toxic damage of medication to ocular surface tissues is mild, poor specificity, and delayed manifestation in patients, especially when coexisting with other ocular surface diseases. Impairment of ocular surface tissues greatly impacts the life quality of patients and subsequently influences compliance with glaucoma therapy. This paper emphasizes to take measures to prevent ocular surface tissue damage resulted from chronic use of topical anti-glaucoma drugs and further discusses the treatment strategy. Effective and long-lasting action drugs should always be selected for glaucomatous patients in order to decrease the frequency of topical instillation or at a more expensive medication, a fixed combination formula can be considered for glaucoma therapy. An early surgery or laser treatment is also proposed for the patients who require an IOP reduction with an existing ocular surface impairment. Future investigation and development of new medications with long-term efficacy and appropriate BKC are suggested and preservative-free or drugs with new preservative materials recommended. （Chin J Ophthalmol , 2011,47：101-104）