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

Comparison of intraocular pressure reducing effects of three prostaglandin eyedrops in open-angleglaucoma

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2l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（18．94±2．1）mmHg（1mmHg=0．133kPa）降至（15．34±2．7）mmHg，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（19．14±3．1）mmHg降至（15．3±2．1）mmHg，下降幅度为19．4％；贝美前列素组眼压从（18．6±1．9）mmHg降至（14．9±1．9）mmHg，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组问眼压值随时问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。（中华腰科杂志，2011，47：109-113）

Objective To compare the efficacy of latanoprost, travoprost and bimatoprost given in the evening on the 24-hour intraocular pressure （IOP） curve in open-angle glaucoma patients. Methods It was a case-control study. Patients with primary open-angle glaucoma were selected for the present study. Twenty-one, 22 and 20 patients were treated once daily with latanoprost, travoprost and bimatoprost for 4 weeks, respectively. Before and four weeks after the treatment, IOP was measured by masked evaluators at 8AM, 10AM, noon, 2PM, 4PM, 6PM, 8PM, 10PM, midnight, 2AM, 4AM and 6AM. Repeated measure analysis of variance was used to compare the lOP responses to the drug regimens for the entire circadian curve. Analysis of variance was used to compare the circadian variations of intraocular pressure. Results The IOPs of all patients in these 3 groups decreased markedly after 4 weeks. The daily average IOP （mean -＋ standard deviation） in the latanoprost group decreased from （18.9±2. 1 ）mm Hg （1 mm Hg = 0. 133 kPa） to （ 15.3 ±2.7） mm Hg, and the extent of the decrease was 19. 0%. IOP in the travoprost group decreased from （19. 1 ±3.1）ram Hgto （15.3 ±2. 1）ram Hg , with a decrease of 19.4 %. IOP in the bimatoprost group decreased from （ 18.6 ±1.9 ）mm Hg to （ 14. 9 ± 1.9 ）mm Hg, with a decrease of 19.9%. The effectiveness of the treatments did not differ significantly between these three groups （ F = 1. 501, P = 0. 110）. The descending percentage compared with circadian variation ranges before treatment in patients with latanoprost, travoprost and bimatoprost was 31.0% , 31.1% and 31.9%, respectively. In comparison of these three groups, the circadian variations of intraocular pressure did not differ significantly（ F = 0. 286, P = 0. 752 ）. Conclusions This study demonstrated that latanoprost, travoprost and bimatoprost are all effective in reducing IOP over the 24-hour curve in primary open-angle glancoma. On the basis of our data,there was no statistically significant difference in the IOP reduction between these three drugs. （Chin J Ophtbalmol , 2011,47 ： 109-113 ）