Achievements and Limits of Current Medical Therapy of Glaucoma
Achievements and Limits of Current Medical Therapy of Glaucoma
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DOI：
10.1159/000458482
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发表时间：
2017-01-01
期刊：
影响因子：
--
通讯作者：
Topouzis, Fotis
中科院分区：
文献类型：
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作者：
Kalouda, Pelagia;Keskini, Christina;Topouzis, Fotis
开出治疗青光眼的药物可能是一个复杂的过程，因为关于它的成就和局限性，应该考虑许多参数。今天，临床医生可以选择多种药物类别和类别内的多种药物，但应注意其副作用和禁忌症。既往存在眼表疾病的青光眼患者应谨慎治疗，最好使用不含防腐剂的制剂，因为症状恶化的风险增加。固定联合疗法的开发和使用减少了威胁患者依从性的防腐剂相关副作用，并最大限度地减少了多次滴注的冲洗效果。坚持治疗不仅对其疗效至关重要，而且对其成本效益也至关重要。进一步需要考虑的因素是，有一些患者对治疗没有反应，而且不是所有患者都能达到目标眼压(IOP)，无论对治疗的反应如何。即使在最大限度的医疗或最大耐受的医疗情况下，无论是否达到低眼压水平，损害的进展都可能发生。此外，由于长期的日常使用和治疗的副作用，医疗和生活质量之间存在一些冲突。人们正在研究新的分子和新的给药系统，以开辟青光眼治疗的新天地。虽然治疗青光眼的一般规则是通过药物治疗来启动青光眼治疗，但在确定需要手术治疗的患者时，应该考虑药物治疗的限度。(C)2017年S.Karger AG，巴塞尔
Prescribing medical therapy for the treatment of glaucoma can be a complex process since many parameters should be taken into consideration regarding its achievements and limits. Today, a variety of options, including multiple drug classes and multiple agents within classes, are available to the clinician, but caution should be given to their side effects and contraindications. Glaucoma patients with preexisting ocular surface disease should be treated with caution, and preferably with preservative-free formulations, as there is an increased risk for symptom deterioration. The development and use of fixed-combination therapies has reduced the preservative-related side effects that threaten patient adherence and has minimized the washout effect of multiple instillations. Adherence to medical treatment is not only crucial to its efficacy but also to its cost-effectiveness. Further factors to consider are that there are patients who are nonresponders to treatment, and also that the target intraocular pressure (IOP) cannot be reached in all patients, regardless of the response to treatment. The progression of damage can occur even under maximum medical treatment or maximally tolerated medical treatment, and regardless of whether low IOP levels are reached. Furthermore, there is some conflict between medical treatment and quality of life due to long-term everyday use and to side effects of treatment. New molecules and new delivery systems are being investigated to open new horizons in glaucoma management. Although the general rule is to initiate glaucoma management with medical treatment, the limits of medical therapy should be considered to identify those patients in need of surgical management. (C) 2017 S. Karger AG, Basel