噻吗洛尔和布林佐胺联合曲伏前列素治疗原发性开角型青光眼与高眼压患者的临床研究

Timolol,brinzolamide and travoprost in treatment of primary open-angle glaucoma and ocular hypertension

目的比较噻吗洛尔和布林佐胺辅助曲伏前列素治疗原发性开角型青光眼(primary open-angle glaucoma,POAG)或高眼压(ocular hypertension,OHT)患者的效果。方法将使用曲伏前列素单剂药物治疗6周后眼压>18mmHg(1kPa=7.5mm-Hg)的POAG及OHT患者随机分为治疗组和对照组。治疗组40例(40眼)加入10g·L-1布林佐胺滴眼液(每日2次),对照组40例(40眼)加入5g·L-1噻吗洛尔滴眼液(每日2次)。随访2周、8周、14周、20周、26周的眼压、血压、心率,观察眼部症状和体征,26周检测与基线对应的相关参量,包括视野、视觉电生理、视网膜神经纤维层厚度、视盘盘沿面积、泪液功能等。计算26周时眼压≤18mmHg患者百分比。结果两组眼压与基线比较均有明显下降,差异均有显著统计学意义(均为P<0.01)。治疗组降眼压持续平稳,对照组眼压于20周后出现上升趋势。24h眼压描记显示治疗组降眼压稳定,昼夜眼压平稳,对照组夜间眼压控制欠佳。2组对患者血压无影响,治疗组对患者心率无影响,对照组在联合用药20周始出现心率抑制。联合用药后对照组视野光敏感度下降,泪膜稳定性下降,治疗组无明显异常。治疗组常见的副作用是眼部刺激症状、味觉异常、口干等,对照组副作用是眼异物感、干涩等。结论曲伏前列素单剂治疗不足时,添加布林佐胺和噻吗洛尔均能进一步降低眼压,布林佐胺长期及短期眼压波动幅度均比噻吗洛尔小,局部及全身副作用小。

Objective To assess the efficacy of timolol,brinzolamide and travoprost on primary open-angle glaucoma（POAG） and ocular hypertension（OHT）.Methods Patients with intraocular pressure（IOP）18 mmHg（1 kPa=7.5 mmHg） after single treatment with travoprost for 6 weeks were randomly divided into treatment group and control group.The treatment group（40 cases,40 eyes） added with 10 gL-1 brinzolamide（2 times per day）,the control group（40 cases,40 eyes） with timolol（2 times per day）.IOP,blood pressure and heart rate were followed up at 2 weeks,8 weeks,14 weeks,20 weeks and 26 weeks,the ocular symptom and physical sign were observed,the parameters related with baseline,such as visual field,visual electrophysiology,retinal nerve fiber layer thickness,neurovetinal rim area and tear function,were measured at 26 weeks.The percentage of patients with IOP≤18 mmHg was also calculated at 26 weeks.Results Compared with baseline,IOP in two groups all decreased,there were significant differences（both P0.01）.IOP in treatment group sustained and stabled,but the rising trend appeared after 20 weeks in control group.＂IOP in 24 hours＂ showed the treatment group reduced IOP stably at night and day,but in control group,IOP reduced poor.There were no influence on blood pressure in two groups,no effect on the heart rat in treatment group,but heart rate suppression appeared at 20 weeks in control group.In control group,the sensitivity of vision decreased,and the tear film stability declined,there was no influence in treatment group.The common adverse reactions in treatment group were ocular stimulate symptoms,abnormal taste and dry mouth,that in control group were foreign body sensation and dry eye.Conclusion When single-agent therapy with travoprost is insufficient,adding timolol and brinzolamide can further reduce IOP.The long-term and short-term fluctuation of IOP with brinzolamide is smaller than that with timolol,and the local and system adverse reactions are also smaller.