维生素A棕榈酸酯眼用凝胶预防抗青光眼药物眼表损伤的作用
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摘要
目的观察维生素A棕榈酸酯眼用凝胶对抗青光眼药物眼表损伤的防治作用。方法选取需要长期应用抗青光眼药物治疗的患者64例90眼,根据用药种类分为两组:噻吗心安组和曲伏前列腺素组。又将两组采用随机对照方式各分为两个亚组:噻吗心安组,噻吗心安+维生素A组,曲伏前列素组,曲伏前列素+维生素A组。用药前及用药3个月后分别进行眼压(Intraocular pressure,IOP)、泪膜破裂时间(Break-up time,BUT)、泪液分泌试验(Schirmer test I,STI)和干眼仪检查,了解用药前后的变化。结果用药后各组的10P均明显下降,差异均有统计学意义。而用药后噻吗心安组和噻吗心安+维生素A组,曲伏前列素组和曲伏前列素+维生素A组IOP差异无统计学意义。用药3个月后噻吗心安组和曲伏前列素组BUT为(6.59±2.51)s和(5.54±1.93)s,较用药前的(7.86±2.61)s和(6.96±1.71)s缩短,差异有统计学意义;STI为(7.23±2.78)mm和(5.96±1.94)mm,较用药前的(8.91±3.41)mm和(7.83±2.84)mm减少,差异有统计学意义;干眼仪正常百分率为22.73%和29.17%,较用药前的54.54%和62.50%降低,差异有统计学意义。用药3个月后噻吗心安+维生素A组和曲伏前列素+维生素A组BUT为(7.75±2.34)s和(7.21±2.21)s,与用药前的(7.95±2.74)s和(7.17±2.20)s相比,差异无统计学意义;STI为(8.65±2.03)mm和(8.63±2.43)mm,与用药前的(8.45±3.14)mm和(8.45±3.14)mm相比,差异无统计学意义;干眼仪正常百分率为55.00%和70.83%,与用药前的65.00%和66.67%相比,差异无统计学意义。结论长期使用抗青光眼药物会造成眼表结构的损害,而维生素A棕榈酸眼用凝胶可以预防抗青光眼药物所造成的眼表损伤且不影响降眼压药物的吸收。
OBJECTIVE To observe whether vitamin A palmitate could prevent the ocular surface damage due to topical antiglaucomatous eyedrops.METHODS Ninety eyes of 64 patients who needed long-term use of antiglaucoma drugs were divided into two groups according to the kind of treatment eyedrop:timolol group and travoprost group.Each group was randomized to two subgroups:timolol group,timolol+vitamin A group,travoprost group,travoprost+vitamin A group.All patients were evaluated for intraocular pressure(IOP),tear break-up time(BUT),Schirmer's test I(STI) and tear interference images before treatment and 3 months after treatment,to acquire the difference between them and get the rule of change.RESULTS The IOP in each group was significantly dropped after the treatment.But there was no statistical significance in IOP between timolol group and timolol+vitamin A group,travoprost group and travoprost+vitamin A group.The BUT in timolol group and travoprost group after treatment was(6.59±2.51) s and(5.54±1.93) s,which was significantly shorter than(7.86±2.61) s and(6.96±1.71) s before treatment.The difference was statistically significant.The STI was(7.23±2.78)rnm and(5.96±1.94)mm,which was significantly lower than(8.91 ±3.41)mm and(7.83±2.84)mm before treatment.The difference was statistically significant.The proportion of normal tear interference image was 22.73%and 29.17%,which was significantly lower than 54.54%and 62.50%before treatment.The difference was statistically significant.In timolol+vitamin A group and travoprost+vitamin A group,there was no significant change in BUT,STI and tear interference image pre and post treatment.CONCLUSIONS Prolonged treatment with antiglaucomatous medications resulted in corneal and conjunctival damage,which could be effectively attenuated by the long-term use of vitamin A palmitate.
OBJECTIVE To observe whether vitamin A palmitate could prevent the ocular surface damage due to topical antiglaucomatous eyedrops.METHODS Ninety eyes of 64 patients who needed long-term use of antiglaucoma drugs were divided into two groups according to the kind of treatment eyedrop:timolol group and travoprost group.Each group was randomized to two subgroups:timolol group,timolol+vitamin A group,travoprost group,travoprost+vitamin A group.All patients were evaluated for intraocular pressure(IOP),tear break-up time(BUT),Schirmer's test I(STI) and tear interference images before treatment and 3 months after treatment,to acquire the difference between them and get the rule of change.RESULTS The IOP in each group was significantly dropped after the treatment.But there was no statistical significance in IOP between timolol group and timolol+vitamin A group,travoprost group and travoprost+vitamin A group.The BUT in timolol group and travoprost group after treatment was(6.59±2.51) s and(5.54±1.93) s,which was significantly shorter than(7.86±2.61) s and(6.96±1.71) s before treatment.The difference was statistically significant.The STI was(7.23±2.78)rnm and(5.96±1.94)mm,which was significantly lower than(8.91 ±3.41)mm and(7.83±2.84)mm before treatment.The difference was statistically significant.The proportion of normal tear interference image was 22.73%and 29.17%,which was significantly lower than 54.54%and 62.50%before treatment.The difference was statistically significant.In timolol+vitamin A group and travoprost+vitamin A group,there was no significant change in BUT,STI and tear interference image pre and post treatment.CONCLUSIONS Prolonged treatment with antiglaucomatous medications resulted in corneal and conjunctival damage,which could be effectively attenuated by the long-term use of vitamin A palmitate.
引文
[1]刘旭阳,陈晓明,洪敏。青光眼治疗药物评价[J].世界临床药物,2007,28(7):404-412.
[2]Noecker RJ,Herrygers LA,Anwaruddin R.Corneal and conjunctival changes caused by commonly used glaucoma medications[J].Cornea,2004,23(5):490-496.
[3]Pisella PJ,Debbasch C,Hamard P,et al.Conjunctival proinflammatory and proapoptotic effects of latanoprost and preserved and unpreserved timolol:an ex vivo and in vitro study[J].Invest Ophthalmol Vis Sci,2004,45(5):1360-1368.
[4]Leung EW,Medeiros FA,Weinreb RN.Prevalence of ocular surface disease in glaucoma patients[J].J Glaucoma,2008,17(5):350-355.
[5]Debbasch C,Brignole F.Pisella PJ,et al.Quaternary ammoniums and other preservatives contribution in oxidative stress and apoptosis on Chang conjunctival cells[J].Invest Ophthalmol Visual Science,2001,42(3):642-652.
[6]De Saint Jean M,Debbasch C,Brignole F,et al.Toxicity of preserved and unpreserved antiglaucoma topical drugs in an in vitro model of conjunctival cells[J].Curr Eye Res,2000,20(2):85-94.
[7]Pisella PJ,Pouliquen P,Baudouin C.Prevalence of ocular symptoms and signs with preserved and preservative free glaucoma medication[J].Br J Ophthalmol,2002,86(4):418-423.
[8]Herreras JM,Pastor JC,Calonge M,et al.Ocular surface,alteration after long-term treatment with antiglaucomatous drug[J].Ophthalmology,1992,99(7):1082-1088.
[9]Baudouin C,de Lunardo C.Short term comparative study of topical2%carteolol with and without benzalkonium chloride in healthy volunteers[J].Br J Ophthalmol,1998,82(1):39-42.
[10]毛真,刘杏,钟毅敏,等.毛果芸香碱和布林佐胺滴眼液对兔眼表组织的影响[J].中国病理生理杂志,2008,24(11):2251-2256.
[11]Yaluac IS,Gedikouglu G,Karagoz Y,et al.Effects of antiglaucoma drags on ocular surface[J].Acta Ophthalmol Scand,1995,73(3):246-248.
[12]Ihan A.Cvenkel B.Conjunctival epithelium expression of HLA-DR in glaucoma patients and its influence on the outcome of filtration surgery[J].Br J Ophthalmol,2000,84(6):648-650.
[13]Shimazaki J,Hanada K,Yagi Y,et al.Changes in ocular surface caused by antiglaucomatous eyedrops:prospective,randomized study for the comparison of 0.5%timolol v 0.12%unoprostone[J].Br J Ophthalmol,2000,84(11):1250-1254.
[14]Kuppens EV,de Jong CA.Stolwijk TR.Effect of timolol with and without preservative on the basal tear turnover in glaucoma[J].Br J Ophthalmol,1995,79(4):339-342.
[15]Kobayashi TK,Tsubota K,Takamiya E,et al.Effect of retinol palmitate as a treatment for dry eye:a cytological evaluation[J].Ophthalmologica,1997,211(6):358-361.
[16]Mojon D,Bascoboinik D,Haas A,et al.Vitamin E inhibi21ts retinal pigment epithelium cell proliferation in vitro[J].Ophthalmic Res,1994,26(5):304-309.
[2]Noecker RJ,Herrygers LA,Anwaruddin R.Corneal and conjunctival changes caused by commonly used glaucoma medications[J].Cornea,2004,23(5):490-496.
[3]Pisella PJ,Debbasch C,Hamard P,et al.Conjunctival proinflammatory and proapoptotic effects of latanoprost and preserved and unpreserved timolol:an ex vivo and in vitro study[J].Invest Ophthalmol Vis Sci,2004,45(5):1360-1368.
[4]Leung EW,Medeiros FA,Weinreb RN.Prevalence of ocular surface disease in glaucoma patients[J].J Glaucoma,2008,17(5):350-355.
[5]Debbasch C,Brignole F.Pisella PJ,et al.Quaternary ammoniums and other preservatives contribution in oxidative stress and apoptosis on Chang conjunctival cells[J].Invest Ophthalmol Visual Science,2001,42(3):642-652.
[6]De Saint Jean M,Debbasch C,Brignole F,et al.Toxicity of preserved and unpreserved antiglaucoma topical drugs in an in vitro model of conjunctival cells[J].Curr Eye Res,2000,20(2):85-94.
[7]Pisella PJ,Pouliquen P,Baudouin C.Prevalence of ocular symptoms and signs with preserved and preservative free glaucoma medication[J].Br J Ophthalmol,2002,86(4):418-423.
[8]Herreras JM,Pastor JC,Calonge M,et al.Ocular surface,alteration after long-term treatment with antiglaucomatous drug[J].Ophthalmology,1992,99(7):1082-1088.
[9]Baudouin C,de Lunardo C.Short term comparative study of topical2%carteolol with and without benzalkonium chloride in healthy volunteers[J].Br J Ophthalmol,1998,82(1):39-42.
[10]毛真,刘杏,钟毅敏,等.毛果芸香碱和布林佐胺滴眼液对兔眼表组织的影响[J].中国病理生理杂志,2008,24(11):2251-2256.
[11]Yaluac IS,Gedikouglu G,Karagoz Y,et al.Effects of antiglaucoma drags on ocular surface[J].Acta Ophthalmol Scand,1995,73(3):246-248.
[12]Ihan A.Cvenkel B.Conjunctival epithelium expression of HLA-DR in glaucoma patients and its influence on the outcome of filtration surgery[J].Br J Ophthalmol,2000,84(6):648-650.
[13]Shimazaki J,Hanada K,Yagi Y,et al.Changes in ocular surface caused by antiglaucomatous eyedrops:prospective,randomized study for the comparison of 0.5%timolol v 0.12%unoprostone[J].Br J Ophthalmol,2000,84(11):1250-1254.
[14]Kuppens EV,de Jong CA.Stolwijk TR.Effect of timolol with and without preservative on the basal tear turnover in glaucoma[J].Br J Ophthalmol,1995,79(4):339-342.
[15]Kobayashi TK,Tsubota K,Takamiya E,et al.Effect of retinol palmitate as a treatment for dry eye:a cytological evaluation[J].Ophthalmologica,1997,211(6):358-361.
[16]Mojon D,Bascoboinik D,Haas A,et al.Vitamin E inhibi21ts retinal pigment epithelium cell proliferation in vitro[J].Ophthalmic Res,1994,26(5):304-309.