短期局部应用抗青光眼药物对眼表影响的前瞻陛研究  

Prospective study of adverse effects induced by short-term topical antiglaucomatous treatment on ocular surface

作　　者：毛真[1] 刘杏[1] 钟毅敏[1] 黄晶晶[1] 王涛[1] 李媚[1] 肖辉[1] 

机构地区：[1]中山大学中山眼科中心,中山大学眼科学国家重点实验室,510060

出　　处：《眼科》2009年第1期46-50,共5页Ophthalmology in China

基　　金：广东省医学科研基金资助项目(B2006060)

摘　　要：目的探讨短期局部应用抗青光眼药物对患者眼表的影响。设计前瞻性病例系列。研究对象原发性开角型青光眼患者18例32眼,激光周边虹膜切除术后眼压偏高需要联合局部抗青光眼药物治疗的原发性闭角型青光眼患者9例12眼。方法将研究对象根据用药种类分为3组:噻吗洛尔组、酒石酸溴莫尼定组和布林佐胺组。所有患者均局部使用一种抗青光眼药物,每日滴用2次。用药前、用药后1个月、2个月和3个月行泪膜破裂时间(BUT)、基础泪液分泌试验(ST)、结膜印迹细胞(IC)检查和评分。主要指标泪膜破裂时间、泪液分泌值和印迹细胞检测评分。结果全部患者用药前BUT的平均值为(5.83±3.74)秒,用药后1个月、2个月和3个月分别为(5.75±3.32)秒、(5.14±3.02)秒和(4.58±2.87)秒;用药前ST平均值为(6.39±3.98)mm,用药后1个月、2个月和3个月分别为(6.16±3.52)mm、(5.59±3.62)mm和(5.02±3.23)mm。用药后1个月BUT值(P=0.335)和ST值(P=0.504)与用药前比较无统计学差异;用药2个月后BUT值和ST值均显著低于用药前水平(P=0.000)。各用药组BUT和ST的变化趋势与总体变化趋势一致。用药后3个月结膜印迹细胞学发生改变,表现为结膜上皮细胞角化,杯状细胞减少,IC评分与用药前比较有统计学差异(P=0.046)。结论使用噻吗洛尔、酒石酸溴莫尼定或布林佐胺滴眼液2个月即可导致患者泪膜稳定性下降,泪液分泌减少;使用3个月后可引起结膜上皮的损伤。Objective To evaluate the ocular surface changes in glaucomatous patients treated with short-term antiglaucomatous eyedrops. Design Prospective case series. Participants Twenty-seven glaucomatous patients treated with antiglaucomatous eyedrops, including 18 primary open-angle glaucoma patients and 9 patients with uncontrolled intraocular pressure after peripheral laser iridotomy. Methods Patients were divided into three groups, and 8 patients were treated with timolol 0.5%, 9 with brimonidine 0.2%, and the other 10 patients with brinzolamide 1%. Tear break-up time and Schirmer＇s test were tested every one month. At the same time, impression cytology specimens were taken and scored in the range 0-3 according to Nelson＇s method after PAS staining. Main Outcome nessures Tear break-up time, Schirmer＇s test result and conjunctvial impression cytology score. Results The average BUT of all patients was （5.83±3.74） s before treatment,and was （5.75±3.32） s, （5.14±3.02） s and （4.58±2.87） s, respectively after treated for one month, two and three months. The average ST in total patients was （6.39±3.98） mm at the beginning,and decreased to （6.16±3.52） mm, （5,59±3.62） mm and （5.02±3.23） mm after medication treatment for one month, two and three months. There was significant decreases in tear break-up time （BUT） and Schirmer＇s test （ST） in every group after treated for 2 months （P=0.000）.Also, the conjunctvial impression cytology scores after treated for 3 months were significantly higher than those before treatment （P=0.046）. Conclusions Our results show abnormal decreased tear secretion and tear film instability induced by topical treatment with timolol, brimonidine, or brinzolamide over the short term. Conjunctival surface change may also happen after the short-term use of antiglaucomatous medication.

关 键 词：青光眼 药物疗法 眼表 

分 类 号：R775[医药卫生—眼科]