曲伏前列素治疗原发性开角型青光眼的疗效及对血清ET-1、MMP、TIMP-2水平的影响

目的:探讨曲伏前列素治疗原发性开角型青光眼的疗效及对血清内皮素-1(ET-1)、基质金属蛋白酶(MMP)、基质金属蛋白酶抑制剂-2(TIMP-2)水平的影响。方法:选择我院2014年5月~2016年5月收治的96例原发性开角型青光眼患者,按治疗方式分作对照组与研究组,每组48例。对照组予以马来酸噻吗洛尔治疗,研究组予以曲伏前列素治疗,两组均持续治疗1个月。比较两组治疗前后血清ET-1、MMP、TIMP-2水平、阻力指数、舒张末期流速、收缩期峰速、房水细胞数、房水闪辉值、眼压、视野光敏感度、视野平均缺损、视力的变化及不良反应的发生情况。结果:治疗后,两组血清ET-1、MMP、TIMP-2水平、阻力指数、房水细胞数、房水闪辉值、眼压、视野平均缺损均较治疗前显著下降(P0.05),且研究组以上指标明显低于对照组(P0.05);两组舒张末期流速、收缩期峰速、视野光敏感度、视力均较治疗前显著上升,且研究组以上指标明显高于对照组(P0.05)。两组不良反应的发生率比较差异无统计学意义(P0.05)。结论:曲伏前列素治疗原发性开角型青光眼患者可有效改善患者的血流动力学及眼部情况,可能与其显著降低血清ET-1、MMP、TIMP-2水平有关。     

复明片联合曲伏前列素滴眼液对原发性开角型青光眼患者眼部血流动力学和房水EPO、sCD44的影响

摘要 目的：探讨复明片联合曲伏前列素滴眼液对原发性开角型青光眼（POAG）患者眼部血流动力学和房水促红细胞生成素（EPO）、可溶性CD44（sCD44）的影响。方法：选择2017年4月~2020年11月在本院接受治疗的112例193眼的POAG患者,根据随机数字表法分为对照组（n=56,96眼）和研究组（n=56,97眼）,对照组患者接受曲伏前列素滴眼液治疗,研究组接受复明片联合曲伏前列素滴眼液治疗,对比两组疗效、眼部血流动力学和房水EPO、sCD44,视力、视野、眼压,观察治疗期间不良反应发生状况。结果：研究组的临床总有效率高于对照组（P<0.05）。治疗12周后,研究组平均光敏感度（MS）、视力高于对照组,24 h眼压平均值小于对照组（P<0.05）。治疗12周后,研究组舒张末期流速（EDV）、收缩期峰值流速（PSV）高于对照组,血流阻力系数（RI）小于对照组（P<0.05）。治疗12周后,研究组房水EPO、sCD44水平低于对照组（P<0.05）。两组不良反应发生率组间对比无统计学差异（P>0.05）。结论：复明片联合曲伏前列素滴眼液治疗POAG患者,可促进患者视力、视野、眼压改善,可能与调节眼部血流动力学和房水EPO、sCD44水平有关。     

曲伏前列素滴眼液治疗开角型青光眼的疗效及对血流动力学的影响

目的:探讨曲伏前列素滴眼液治疗开角型青光眼的疗效及对血流动力学的影响。方法:选择2013年3月~2015年12月在我院接受治疗的164例开角型青光眼患者为研究对象,按照随机数字表法分为对照组和试验组,每组82例,对照组给予马来酸噻吗洛尔滴眼,试验组给予曲伏前列素滴眼,12周后观察两组患者的降眼压效果和视力改变情况,彩色多普勒超声检测眼动脉(OA)、睫状后短动脉(SPCA)及视网膜中央动脉(CRA)的收缩期血流峰值速度(PSV)、舒张末期血流速度(EDV)和阻力指数(RI),并观察其不良反应。结果:两组患者治疗前和治疗后2周的眼压和视力比较,差异无统计学意义(P0.05)。治疗后,两组患者的眼压与治疗前比较均降低,视力与治疗前比较均提升,且试验组眼压降低及视力提升更显著,差异有统计学意义(P0.05);治疗6周和12周后,试验组患者的眼压低于对照组,视力高于对照组,差异有统计学意义(P0.05)。治疗12周后试验组患者OA、SPCA及CRA的EDV、PSV均高于对照组,而RI均低于对照组,差异有统计学意义(P0.05)。两组患者的不良反应主要为轻度异物感、轻度结膜充血、虹膜色素加深等,两组患者的不良反应发生率比较,差异无统计学意义(P0.05)。结论:曲伏前列素滴眼液治疗开角型青光眼可降低眼压,提高视力,改善眼部血流动力学指标,且安全性较好,值得临床推广应用。     

曲伏前列腺素滴眼液对原发性开角型青光眼患者眼压、血流动力学及ET-1、TIMP-2的影响

目的:探讨曲伏前列腺素滴眼液对原发性开角型青光眼(POAG)患者眼压、血流动力学及内皮素-1(ET-1)、基质金属蛋白酶-2抑制因子(TIMP-2)的影响。方法:选取2015年2月至2017年2月我院眼科收治的70例患者,按照随机数字表法分为对照组和观察组,每组各35例,对照组和观察组患者分别给予马来酸噻吗洛尔滴眼液和曲伏前列腺素滴眼液治疗,治疗周期为3个月。对比分析治疗前、治疗4周、8周及12周后两组患者的平均眼压(IOP)、昼夜IOP差,并对比治疗前、治疗12周后的睫状后动脉(PCA)、视网膜中央动脉(CRA)、收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)、血管阻力指数(RI)、血浆ET-1及房水TIMP-2的改善情况。结果:治疗前两组患者平均IOP、昼夜IOP差、PCA和CRA血流动力学、血浆ET-1及房水TIMP-2差异无统计学意义(P0.05);治疗4周、8周、12周后,两组平均IOP、昼夜IOP差明显低于治疗前,且治疗12周后观察组平均IOP、昼夜IOP差低于对照组,差异均有统计学意义(P0.05);治疗12周后,观察组PCA和CRA的PSV、EDV高于治疗前,RI低于治疗前,差异均有统计学意义(P0.05),且观察组PCA和CRA的PSV、EDV高于对照组,RI低于对照组,差异均有统计学意义(P0.05);治疗12周后,两组患者血浆ET-1和房水TIMP-2较治疗前显著下降,且观察组血浆ET-1和房水TIMP-2含量低于对照组,差异均有统计学意义(P0.05)。结论:曲伏前列腺素滴眼液治疗POAG患者,能够有效降低患者的眼压、血浆ET-1、房水TIMP-2水平,并改善患者PCA、CRA的血流动力学。     

马来酸噻吗洛尔眼液联合拉坦前列素眼液对原发性开角型青光眼患者眼压的影响

目的:探讨马来酸噻吗洛尔眼液联合拉坦前列素眼液对原发性开角型青光眼患者眼压的影响。方法:选取2015年1月-2016年5月在我院接受治疗的原发性开角型青光眼患者84例,其中给予马来酸噻吗洛尔眼液治疗的42例记为对照组,给予拉坦前列素眼液联合马来酸噻吗洛尔眼液治疗的42例记为观察组,两组均治疗6个月。对比两组患者治疗过程中的眼压变化情况,并对比两组患者的临床总有效率、药物依从性和并发症情况。结果:观察组治疗2、4、6个月后的眼压均显著低于对照组(P0.05),观察组患者治疗6个月后与治疗前的眼压差值大于对照组(P0.05)。两组患者治疗2、4、6个月后的眼压呈下降趋势,两两比较差异均有统计学意义(P0.05)。观察组的临床总有效率95.24%显著高于对照组的80.95%(P0.05)。两组患者在治疗过程中结膜充血、眼内异物感、眼睛疼痛、视力模糊、味觉异常以及总并发症发生率对比差异不显著(P0.05)。观察组患者的药物依从性比例显著低于对照组(P0.05)。结论:马来酸噻吗洛尔眼液联合拉坦前列素眼液治疗原发性开角型青光眼患者具有较好的临床疗效,可显著降低患者眼压,同时具有较好的安全性,但药物依从性较差。     

布林佐胺与噻吗洛尔滴眼液对新生血管性青光眼患者眼压及血清和房水IL-6、PEDF和VEGF水平的影响

目的:探讨布林佐胺联合噻吗洛尔滴眼液对新生血管性青光眼(NVG)患者眼压及血清和房水中白细胞介素-6(IL-6)、色素上皮衍生因子(PEDF)、血管内皮生长因子(VEGF)水平的影响。方法:选取我院2014年6月～2016年12月择期行手术治疗的86例NVG患者,按照随机数字表法均分为两组。对照组术后采取噻吗洛尔滴眼液治疗,观察组在此基础上加用布林佐胺滴眼液治疗。记录比较两组临床疗效,治疗前后眼压及血清和房水中IL-6、PEDF和VEGF水平的变化及不良反应的发生情况。结果:术后6个月,观察组总有效率为95.3%,较对照组明显升高(79.1%,P0.05)。与术前对比,两组术后7天、6个月时24 h眼压峰值、平均眼压、眼压波动值、血清和房水中IL-6、VEGF水平均显著下降(P0.01),血清和房水中PEDF水平均显著上升(P0.01),且观察组以上眼压指标较对照组同期改善更为明显(P0.01)。对照组和观察组不良反应的发生率对比差异无统计学意义(7.0%vs 11.6%,P0.05)。结论:术后应用布林佐胺联合噻吗洛尔滴眼液治疗NVG患者更能有效降低眼压和控制其波动,调节机体血管生成促进/抑制因子平衡,提高治疗效果,且安全性高。     

温敏性几丁糖填充兔眼玻璃体两种手术方式对比研究

目的:通过两种手术方式对兔眼玻璃体进行温敏性几丁糖填充,比较其眼压及并发症差异。方法:将18只白兔随机分为实验组和对照组,每组各9只,右眼均为手术眼,实验组白兔行玻璃体切割术并注入温敏性几丁糖,对照组通过1 m L注射器抽取玻璃体并填充温敏性几丁糖,术后随访1月,对比两组白兔术后眼压及手术并发症的差异性。结果:实验组手术前眼压(7.76±2.21)mm Hg与术后眼压(7.49±2.98)mm Hg无明显差异(P0.05),对照组手术前眼压(7.80±2.04)mm Hg与手术后眼压(5.17±0.96)mm Hg有统计学意义(P0.05)。对照组术后并发症发生率为44.4%(4/9),明显高于实验组22.2%(2/9)。结论:玻璃体腔注射温敏性几丁糖操作简单,但并发症较多,且易造成眼压改变;而玻璃体切割术后填充温敏性几丁糖并发症相对较少,眼压波动较小,但应注意并发性白内障的发生。     

应用米索前列醇治疗妊高症产后出血的疗效观察

目的:探讨应用米索前列醇对妊高症产后出血的治疗效果。方法:选取我院诊治的200例妊高症产后出血孕妇,将患者分为观察组与对照组,每组100例患者,胎儿娩出后对照组肌注催产素,观察组直肠给予米索丽列醇,按摩子宫,比较治疗后两组患者的平均出血量以及血压状况。结果:治疗前对照组和观察组平均出血量分别为(623.2±45.8)m L、(630.0±46.3)m L(P1=0.176)。治疗后,两组平均出血量分别为(486.1±24.3)m L、(313.3±23.1)m L。与治疗前相比,治疗后两组产妇的出血量均有不同减少,观察组患者少于对照组患者(P2=0.026)。对照组中重度妊高症患者的收缩压及舒张压分别为(170.1±6.7)mm Hg、(113.2±2.1)mm Hg,中度(153.6±5.1)mm Hg、(104.5±5.3)mm Hg,轻度(138.9±4.2)mm Hg、(93.2±2.0)mm Hg。观察组重度妊高症患者中以上指标分别为(169.2±6.5)mm Hg、(114.4±2.5)mm Hg,中度患者(156.2±4.8)mm Hg、(105.9±4.9)mm Hg,轻度患者(140.2±4.4)mm Hg、(90.2±4.4)mm Hg,相应病情下两组患者血压方面均无统计学差异(P3=0.87,P4=0.88,P5=0.75,P6=0.83,P7=0.64,P8=0.92)。对照组和观察组患者中不良反应发生率分别为1.0%(1/100)、2.0%(2/100),差异无统计学意义(P0.05)。结论:米索前列醇直肠用药治疗妊高症产后出血,疗效显著、给药方便、安全性较高,值得进一步推广。     

他氟前列素与拉坦前列素治疗慢性开角型青光眼疗效相当

为了对他氟前列素用于开角型青光眼治疗提供实验依据,本研究对比观察抗青光眼新药他氟前列素和常用药物拉坦前列素治疗慢性开角型青光眼的疗效。我们选取2014年08月至2015年12月我院收治的120例原发性慢性开角型青光眼患者,按随机数字表法分为他氟前列素组(0.001 5%,1次/d,1滴/次)和拉坦前列素组(0.005%,1次/d,1滴/次),对比观察两组患者的眼压、视野缺损、角膜中央厚度、前房深度和视网膜中央动脉血流动力学指标。研究结果如下:(1)治疗后两组的眼压和视野缺损度显著降低(p0.05),且拉坦前列素组的视野缺损改善更为显著(p0.05);(2)治疗后两组的角膜中央厚度显著降低(p0.05),但两组的前房深度与治疗前比较无差异(p0.05);(3)治疗后两组的PSV、EDV升高而RI降低(p0.05)。以上结果提示,新药他氟前列素对青光眼患者的治疗效果与临床常用药物拉坦前列素相当,同时在改善患者的视野缺损度方面优于拉坦前列素,且安全性好,值得临床推广使用。     

益气宁心汤联合贝那普利治疗慢性心衰患者的临床疗效及对血清GDF-15、sST2、APN的影响

目的:研究益气宁心汤联合贝那普利治疗慢性心衰患者的临床疗效及对血清生长分化因子-15(GDF-15)、可溶性ST2蛋白(s ST2)、脂联素(APN)的影响。方法:收集2014年3月至2015年3月我院收治的80例慢性心衰患者,按抽签法分为实验组和对照组,每组40例。两组均给予常规基础对症治疗,对照组在此基础上加用贝那普利治疗,每次10 mg,每天1次,实验组在对照组的基础上加用益气宁心汤治疗,每天1剂,于早晚服用,两组治疗疗程均为2周。观察和比较两组的临床疗效及治疗前后心功能左心室舒张末径(LVEDD)、左心室收缩末期内径(LVESD)、左室射血分数(LVEF),GDF-15、s ST2、APN水平、急性生理学与慢性健康状况评分(APACHE-Ⅱ)、肺部感染评分(CPIS)的变化。结果:治疗后,实验组总有效率显著高于对照组[92.50%(37/40)vs72.50%(29/40)](P0.05);LVEDD、LVESD显著低于对照组[(53.56±6.24)mm vs(57.40±6.72)mm,(41.26±4.95)mm vs(46.28±4.86)mm](P0.05),LVEF显著高于对照组[(57.91±5.93)%vs(50.27±5.90)%](P0.05);血清GDF-15、s ST2、APN水平显著低于对照组[(820.81±73.14)ng/L vs(1192.86±93.62)ng/L,(4.28±1.02)ng/mL vs(20.69±3.48)ng/mL,(13.47±2.18)mg/L vs(16.05±3.63)mg/L](P0.05);APACHE-Ⅱ、CPIS评分显著低于对照组[(13.90±3.28)分vs(20.37±4.97)分,(3.24±0.92)分vs(5.38±1.01)分](P0.05)。结论:益气宁心汤联合贝那普利治疗慢性心力衰竭能显著提高其临床疗效,改善心心功能,可能与其有效降低血清GDF-15、s ST2、APN的水平有关。     

Selective laser trabeculoplasty in the treatment of pseudoexfoliation glaucoma in patients allergic to all anti-glaucoma drops

Secondary chronic open-angle glaucoma associated with pseudoexfoliation (PEX) syndrome accounts for approximately 25% of all glaucomas and represents the most common identifiable cause of glaucoma overall. Selective laser trabeculoplasty (SLT) is effective in reducing intraocular pressure (IOP) in glaucomatous patients and has the advantage of preserving surrounding structures. We report here SLT treatment of a 82 year old female with a secondary developed open-angle pseudoexfoliation glaucoma allergic to all anti glaucoma eye drops especially those which contain bensalconium chloridum as preservative. Since patient was allergic also to methyl-cellulose, we performed SLT with water as a mediator. Patient had PEX syndrome for 10 years, immature cataracts on both eyes, and best corrected visual acuity (BCVA) 0.7 on the right and 0.2 on the left eye. We have monitored intraocular pressure (IOP), the changes in the visual field and optic nerve. Preoperative IOP was 28 mmHg on the right and 30 mmHg on the left eye. The follow up period was 24 months with time points for measured parameters every 3 months. After 18 months IOP remained in the normal values (average 17 mmHg) on the right eye, but on the left eye it increased up to 28 mmHg. SLT re-treatment was carried out on the left eye and the IOP stabilized again on the values between 16-18mmHg. There were no significant change in the visual field and optic nerve configuration before and after SLT (C/D value for right eye: 0.3-0.4; C/D left eye: 0.5). Based on this case report, SLT seems to be very effective treatment for maintaining regular IOP in patient with PEX who is allergic to all types of medications.     

Ocular Cubosome Drug Delivery System for Timolol Maleate: Preparation,Characterization, Cytotoxicity, <Emphasis Type="Italic">Ex Vivo</Emphasis>, and <Emphasis Type="Italic">In Vivo</Emphasis> Evaluation

Glaucoma is an ocular disease featuring increased intraocular pressure (IOP) and its primary treatment strategy is to lower IOP by medication. Current ocular drug delivery in treating glaucoma is confronting a variety of challenges, such as low corneal permeability and bioavailability due to the unique anatomical structure of the human eye. To tackle these challenges, a cubosome drug delivery system for glaucoma treatment was constructed for timolol maleate (TM) in this study. The TM cubosomes (liquid crystalline nanoparticles) were prepared using glycerol monooleate and poloxamer 407 via high-pressure homogenization. These constructed nanoparticles appeared spherical using transmission electron microscopy and had an average particle size of 142 nm, zeta potential of ?6.27 mV, and over 85% encapsulation efficiency. Moreover, using polarized light microscopy and small-angle X-ray scattering (SAXS), it was shown that the TM cubosomes have cubic liquid crystalline D-type (Pn3m) structure, which provides good physicochemical stability and high encapsulation efficiency. Ex vivo corneal permeability experiments showed that the total amount of TM cubosomes penetrated was higher than the commercially available eye drops. In addition, in vivo studies revealed that TM cubosomes reduced the IOP in rabbits from 27.8～39.7 to 21.4～32.6 mmHg after 1-week administration and had a longer retention time and better lower-IOP effect than the commercial TM eye drops. Furthermore, neither cytotoxicity nor histological impairment in the rabbit corneas was observed. This study suggests that cubosomes are capable of increasing the corneal permeability and bioavailability of TM and have great potential for ocular disease treatment.     

不同术式治疗新生血管性青光眼的疗效比较

目的:比较不同手术方法治疗新生血管性青光眼(neovascular glaucoma,NVG)的疗效。方法:对接受不同术式治疗的57例57只眼NVG的临床资料进行回顾性分析,其中行单纯睫状体冷凝术20例(A组),改良小梁切除术15例(B组),引流阀植入术联合全视网膜光凝术22例(C组)。比较各组患者手术前后主观眼痛症状、眼压及视力变化情况,并随访3~6个月。结果:A组患者出院时的平均眼压为(28.13±4.83)mmHg,B组为(19.24±5.48)mmHg,C组为(21.22±4.76)mmHg。随访期间,术后A组9例眼压正常,手术成功率45%;B组11例眼压正常,手术成功率73.3%;C组13例眼压正常,手术成功率57.1%。B组手术成功率最高,A组最低。结论:三种手术方法均可不同程度降低新生血管性青光眼的眼压。单纯睫状体冷凝术后眼压控制效果欠佳,有视力眼不宜采用此种手术方式;改良小梁切除术是治疗新生血管性青光眼安全、有效、经济的手术方式;引流阀植入术联合全视网膜光凝术费用较高。     

Intraocular Pressure-Lowering Effects of Commonly Used Fixed-Combination Drugs with Timolol: A Systematic Review and Meta-Analysis

Background

The first goal of medical therapy in glaucoma is to reduce intraocular pressure (IOP), and the fixed-combination medications are needed to achieve sufficiently low target IOP. The aim of this systematic review and meta-analysis is to evaluate IOP-lowering effect of the commonly used fixed-combination drugs containing 0.5% timolol.

Methods

Pertinent publications were identified through systematic searches. Over 85% of the patients had to be diagnosed with primary open-angle glaucoma (POAG) or ocular hypertension (OHT). Forty-one randomized clinical trials were included in the meta-analysis. The main efficacy measures were the absolute and relative values of mean diurnal IOP reduction, and the highest and lowest IOP reductions on the diurnal IOP curve. The pooled 1- to 3-month IOP-lowering effects after a medicine-free washout period was calculated by performing meta-analysis using the random effects model, and relative treatment effects among different fixed combinations were assessed using a mixed-effects meta-regression model.

Results

The relative reductions for mean diurnal IOP were 34.9% for travoprost/timolol, 34.3% for bimatoprost/timolol, 33.9% for latanoprost/timolol, 32.7% for brinzolamide/timolol, 29.9% for dorzolamide/timolol, and 28.1% for brimonidine/timolol. For the highest IOP decrease, relative reductions ranged from 31.3% for dorzolamide/timolol to 35.5% for travoprost/timolol; for the lowest IOP decrease, those varied from 25.9% for dorzolamide/timolol to 33.1% for bimatoprost/timolol. Both latanoprost/timolol and travoprost/timolol were more effective in lowering mean diurnal IOP than brimonidine/timolol (WMD: 5.9 and 7.0) and dorzolamide/timolol (WMD: 3.8 and 3.3).

Conclusions

All six commonly used fixed-combination drugs containing timolol can effectively lower IOP in patients with POAG and OHT, and both latanoprost/timolol and travoprost/timolol might achieve better IOP-lowering effects among the six fixed-combination agents.     

Effect of latanoprost on intraocular pressure,visual acuity and C-reactive protein

ObjectiveTo investigate the effect of latanoprost on intraocular pressure (IOP), visual acuity and C-reactive protein (CRP) in patients with primary open-angle glaucoma (POAG).MethodsA total of 163 POAG patients (266 eyes) admitted to our hospital from February 2015 to July 2017 were selected and divided into observation group (81 cases, 132 eyes, latanoprost eye drops) and control group (82 cases, 134 eyes, timolol maleate eye drops) according to different treatment plans. The clinical efficacy of the two groups after treatment was evaluated. The IOP, visual acuity and CRP level were compared between the two groups before and after treatment. Then the adverse reactions of the two groups were observed and recorded.ResultsAfter treatment, the total effective rate was 92.59% (75 cases) in the observation group and was 80.49% (66 cases) in the control group, with statistic difference between groups (P < 0.05); The IOP, visual acuity and CRP level between the two groups before treatment showed no statistic difference, the mentioned three indexes of the two groups were significantly improved after treatment, and statistic difference was found before and after treatment (P < 0.05); Moreover, the above three indicators had statistically significant differences between groups after treatment (P < 0.05); The difference of intraocular pressure and visual acuity between the two groups before and after treatment were statistically different (P < 0.05); After treatment, the incidence of adverse reactions in the observation group such as allergy, vomiting, breathlessness and tachycardia were not significantly different from those in the control group (P > 0.05).ConclusionLatanoprost can improve IOP, visual acuity, and CRP levels. It improves eye hemodynamics, and has significant efficacy in treating primary open-angle glaucoma. Also, it has good security.