Effect of dorzolamide and timolol on ocular blood flow in patients with primary open angle glaucoma and ocular hypertension
Effect of dorzolamide and timolol on ocular blood flow in patients with primary open angle glaucoma and ocular hypertension
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DOI：
10.1136/bjo.2005.067637
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发表时间：
2005-10-01
影响因子：
4.1
通讯作者：
Schmetterer, L
中科院分区：
文献类型：
--
作者：
Fuchsjäger-Mahrl, G;Wally, B;Schmetterer, L
背景：有证据表明视神经乳头灌注异常与青光眼的发病机制有关。因此，人们对局部抗青光眼药物对眼血流的影响非常感兴趣。一项研究比较了多佐胺和噻吗洛尔对原发性开角型青光眼 (POAG) 或高眼压症 (OHT) 患者的眼血流动力学影响。方法：将 140 名 POAG 或 OHT 患者纳入一项对照、随机、双盲研究，分为两个平行组； 70 名患者随机接受噻吗洛尔治疗，70 名患者随机接受多佐胺治疗，为期 6 个月。眼压（IOP）对两种药物均无反应的受试者在两周后转为替代治疗。使用扫描激光多普勒血流计测量颞神经视网膜边缘和视神经乳头杯的血流。采用激光干涉测量眼底搏动幅度来评估脉络膜血流。结果：5名患者对噻吗洛尔没有反应而改为多佐胺组，18名患者从多佐胺治疗改为噻吗洛尔组。两种药物对眼压和眼灌注压的影响相当。多佐胺而非噻吗洛尔增加了颞神经视网膜边缘的血流量（与噻吗洛尔相比为 8.5 (1.6)%，p < 0.001）和视神经乳头杯（与噻吗洛尔相比为 13.5(2.5)%，p < 0.001）和眼底搏动幅度（与噻吗洛尔相比为 8.9(1.3)%，p < 0.001）。结论：这项研究表明，用多佐胺治疗 6 个月后，视神经乳头和脉络膜的血流量增加，但噻吗洛尔则没有。这种效应是否有助于减少青光眼患者的视野丧失仍有待确定。
Background: There is evidence that perfusion abnormalities of the optic nerve head are involved in the pathogenesis of glaucoma. There is therefore considerable interest in the effects of topical antiglaucoma drugs on ocular blood flow. A study was undertaken to compare the ocular haemodynamic effects of dorzolamide and timolol in patients with primary open angle glaucoma (POAG) or ocular hypertension (OHT).Methods: One hundred and forty patients with POAG or OHT were included in a controlled, randomised, double blind study in two parallel groups; 70 were randomised to receive timolol and 70 to receive dorzolamide for a period of 6 months. Subjects whose intraocular pressure (IOP) did not respond to either of the two drugs were switched to the alternative treatment after 2 weeks. Scanning laser Doppler flowmetry was used to measure blood flow in the temporal neuroretinal rim and the cup of the optic nerve head. Pulsatile choroidal blood flow was assessed using laser interferometric measurement of fundus pulsation amplitude.Results: Five patients did not respond to timolol and were changed to the dorzolamide group, and 18 patients changed from dorzolamide treatment to timolol. The effects of both drugs on IOP and ocular perfusion pressure were comparable. Dorzolamide, but not timolol, increased blood flow in the temporal neuroretinal rim (8.5 (1.6)%, p < 0.001 versus timolol) and the cup of the optic nerve head (13.5(2.5)%, p < 0.001 versus timolol), and fundus pulsation amplitude (8.9(1.3)%, p < 0.001 versus timolol).Conclusions: This study indicates augmented blood flow in the optic nerve head and choroid after 6 months of treatment with dorzolamide, but not with timolol. It remains to be established whether this effect can help to reduce visual field loss in patients with glaucoma.