一例初診開角型青光眼患者的循證治療_《中國循證醫學雜志》

作者：

錢志剛 ,  柯敏 , 郭敬 , 胡昕倩

武漢大學中南醫院眼科（武漢 430071）;

關鍵詞：

開角型青光眼噻嗎洛爾拉坦前列腺小梁切除術循證治療

DOI：

10.7507/1672-2531.20100554

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目的　借助循證醫學的方法為1例雙眼開角型青光眼（POAG）患者確定治療目標及治療方案，同時對諸多文獻報道的POAG治療進行回顧性總結。
方法　在充分評估患者情況后，提出臨床問題，在Cochrane Library（2009年第4期）、PubMed數據庫（1990～2009），MEDLINE（1990～2009）、EMbase（1990～2009）、CBM（1990～2009）、CNKI（1990～2009）中收集證據并評價其實用性。檢索主題詞包括open-angle glaucoma、timolol、latanoprost、 trabeculectomy、intraocular pressure、RCT、human、meta-analysis、systematic review。中文檢索詞包括：開角型青光眼、噻嗎洛爾、拉坦前列腺、小梁切除術、系統評價、Meta分析、隨機對照試驗。
結果　共檢索出開角型青光眼治療的臨床指南3篇，不同問題相關的隨機對照試驗221篇，系統評價/Meta分析19篇。通過分析檢索結果并結合患者意愿，為患者制定出合理的治療方案。
結論　采用循證醫學的方法，為初診開角型青光眼患者確定合理的治療方案，可有效提高患者治療效果。

引用本文： 錢志剛,柯敏,郭敬,胡昕倩. 一例初診開角型青光眼患者的循證治療. 中國循證醫學雜志, 2010, 10(9): 1120-1124. doi: 10.7507/1672-2531.20100554 復制

1.	Palmberg P, Traget IOP. How low? American Academy of Ophthalmology Subspecialty Day glaucoma meeting; 2001Nov 10; New Orleans.
2.	Tuulonen A, Airaksinen PJ. The Finnish evidence-based guideline for open-angle glaucoma. Acta Ophthalmol. Scand, 2003, 81: 3-18.
3.	Collaborative Normal-tension Glaucoma Study Group (CNTGS). The effectiveness of intraocular pressure reduction in the treatment of normal-tension glaucoma. Am J Ophthalmol, 1998, 126(4): 498-505.
4.	Capr iol IJ, Fasterland DE, Gross RL, et al. Preferred practice pattern for primary open-angle glaucoma. San Francisco: American Academy of Ophthalmology, 2002: 1-2.
5.	The Collaborative Initial Glaucoma Treatment Study: interim quality of life findings after initial medical or surgical treatment of glaucoma.Ophthalmology. Janz NK, Wren PA, Lichter PR, Musch DC, Gillespie BW, Guire KE, Mills RP; CIGTS Study Group. 2001 Nov; 108(11): 1954-1965.
6.	Whitson JT. Glaucoma: a review of adjunctive therapy and new management strategies. Expert Op in Pharmacother, 2007, 8(18): 3237-3249.
7.	Mundorf TK, Ogawa T, Naka H, et al. US Istalol Study Group.A 12-month, multicenter, randomized, double-masked, parallel-group comparison of timolol-LA once daily and timolol maleate ophthalmic solution twice daily in the treatment of adults with glaucoma or ocular hypertension. Clin Ther, 2004, 26(4): 541-51.
8.	Husan S, Crosson CE. Role of PK cepsilon in PGF-alpha2 stimulated MMP-2 secretion from human ciliary muscle cells. J Ocul Pharmacol Ther, 2008, 24(3): 268-277.
9.	Ishda N, Odan I-Kawabata N, Sh imazaki A, et al. Prostanoids in the therapy of glaucoma. Cardiovasc Drug Rev, 2006, 24 (1): 1-10.
10.	張銘志, 傅智伏, 劉曉瑞, 等. 原發性開角型青光眼與正常人群搏動性眼血流量比較研究. 中華眼科雜志, 2004 , 40: 250-253.
11.	Lim KS, Nau CB, Megan M, et al. Mechanism of action of bimatoprost, latanoprost, and travoprost in health subjects. A cross-over study. Ophthalmology, 2008, 115(5): 790-795.
12.	Cunl IFFE I. New drugs in glaucoma therapy. Hospital Medicine, 2003, 64(3): 156-160.
13.	Brubaker RF, Schoff EO, Nau CB, et al. Effects of AGN 192024, a new ocular hypotensive agent, on aqueous dynamics. Am J Ophthalmol, 2001, 131(1): 19-24.
14.	Grieshaber MC, Flammer J. Blood flow in glaucoma. Curr Op in Ophthalmol, 2005, 16(2): 79-83.
15.	Ishii K, Tomidokoro A, Nagahara M, et al. Effects of topical latanoprost on optic nerve head circulation in rabbits, monkey,and humans. Invest Ophthalmol Vis Sci, 2001, 42 (12): 2957-2963.
16.	Alm A, Stjernschantz J. Latanoprost administered once daily caused a maintained reduction of intraocular pressure in glaucoma patients treated concomitantly with timolol. Br J Ophthalmol, 1995, 79(1): 12-16.
17.	Camras CB, the United States latanoprost Study Group. Comparison of latanoprost and timolol in patients with ocular hypertension and glaucoma: a six-month masked, multicenter trial in the United States.Ophthalmology, 1996, 103: 138-147.
18.	Watson P, Stjernschantz J, the latanoprost Study Group. A six-month, randomized, double-masked study comparing latanoprost with timolol in open-angle glaucoma and ocular hypertension.Ophthalmology, 1996, 103: 126-137.
19.	Fristr?m B. A 6-month, randomized, double-masked comparison of latanoprost with timolol in patients with open angle glaucoma or ocular hypertension. Acta Ophthalmol Scand, 1996, 74(2): 140-144.
20.	Perry CM, McGavin JK. Latanoprost: an update of its use in glaucoma and ocular hypertension. Drugs Aging, 2003, 20(8): 597-630.
21.	彭大偉, 李紹珍, 等. latanoprost 與噻嗎心安治療開角型青光眼及高眼壓癥的臨床對照研究. 中華眼科雜志, 2000, 36(4): 285-288.
22.	Hitchings RA. Primary surgery for primary open angle glaucoma--justified or not? Br J Ophthalmol, 1993, 77: 445-448.
23.	Jay JL. Rational choice of therapy in primary open angle glaucoma. Eye(Lond), 1992, 6: 243-247.
24.	葉天才, 張秀蘭, 等. 非穿透性小梁手術聯合透明質酸植入物治療開角型青光眼. 中華眼科雜志, 2001, 37(4): 273-277.
25.	Burr J, Azuara-Blanco A, Avenell A. Medical versus surgical interventions for open angle glaucoma. Cochrane Database Syst Rev, 2005, 18(2).
26.	Webers CA, van der Valk R, Schouten JS, et al. Intraocular pressure-lowering effect of adding dorzolamide or latanoprost to timolol: a meta-analysis of randomized clinical trials. Ophthalmology, 2007, 114(1): 40-46.
27.	Lesk MR, Koulis T, Sampalis F, et al. Effectiveness and safety of dorzolamide-timolol alone or combined with latanoprost in open-angle glaucoma or ocular hypertension. Ann Pharmacother, 2008, 42(4): 498-504.
28.	Hodgew G, Lachaine J, Steffensen I, et al. The efficacy and harm of prostaglandin analogues for IOP reduction in glaucoma patient compared to dorzolaminde and brimonidine: a systematic review. Br J Ophthalmol, 2008, 92(1): 7-12.
29.	梅麗克木?艾山, 具爾提?哈德爾. 多佐胺和噻嗎洛爾聯用與拉坦前列腺素比較治療開角型青光眼的系統評價. 中國循證醫學雜志, 2009, 9(3): 350-354.

1. Palmberg P, Traget IOP. How low? American Academy of Ophthalmology Subspecialty Day glaucoma meeting; 2001Nov 10; New Orleans.
2. Tuulonen A, Airaksinen PJ. The Finnish evidence-based guideline for open-angle glaucoma. Acta Ophthalmol. Scand, 2003, 81: 3-18.
3. Collaborative Normal-tension Glaucoma Study Group (CNTGS). The effectiveness of intraocular pressure reduction in the treatment of normal-tension glaucoma. Am J Ophthalmol, 1998, 126(4): 498-505.
4. Capr iol IJ, Fasterland DE, Gross RL, et al. Preferred practice pattern for primary open-angle glaucoma. San Francisco: American Academy of Ophthalmology, 2002: 1-2.
5. The Collaborative Initial Glaucoma Treatment Study: interim quality of life findings after initial medical or surgical treatment of glaucoma.Ophthalmology. Janz NK, Wren PA, Lichter PR, Musch DC, Gillespie BW, Guire KE, Mills RP; CIGTS Study Group. 2001 Nov; 108(11): 1954-1965.
6. Whitson JT. Glaucoma: a review of adjunctive therapy and new management strategies. Expert Op in Pharmacother, 2007, 8(18): 3237-3249.
7. Mundorf TK, Ogawa T, Naka H, et al. US Istalol Study Group.A 12-month, multicenter, randomized, double-masked, parallel-group comparison of timolol-LA once daily and timolol maleate ophthalmic solution twice daily in the treatment of adults with glaucoma or ocular hypertension. Clin Ther, 2004, 26(4): 541-51.
8. Husan S, Crosson CE. Role of PK cepsilon in PGF-alpha2 stimulated MMP-2 secretion from human ciliary muscle cells. J Ocul Pharmacol Ther, 2008, 24(3): 268-277.
9. Ishda N, Odan I-Kawabata N, Sh imazaki A, et al. Prostanoids in the therapy of glaucoma. Cardiovasc Drug Rev, 2006, 24 (1): 1-10.
10. 張銘志, 傅智伏, 劉曉瑞, 等. 原發性開角型青光眼與正常人群搏動性眼血流量比較研究. 中華眼科雜志, 2004 , 40: 250-253.
11. Lim KS, Nau CB, Megan M, et al. Mechanism of action of bimatoprost, latanoprost, and travoprost in health subjects. A cross-over study. Ophthalmology, 2008, 115(5): 790-795.
12. Cunl IFFE I. New drugs in glaucoma therapy. Hospital Medicine, 2003, 64(3): 156-160.
13. Brubaker RF, Schoff EO, Nau CB, et al. Effects of AGN 192024, a new ocular hypotensive agent, on aqueous dynamics. Am J Ophthalmol, 2001, 131(1): 19-24.
14. Grieshaber MC, Flammer J. Blood flow in glaucoma. Curr Op in Ophthalmol, 2005, 16(2): 79-83.
15. Ishii K, Tomidokoro A, Nagahara M, et al. Effects of topical latanoprost on optic nerve head circulation in rabbits, monkey,and humans. Invest Ophthalmol Vis Sci, 2001, 42 (12): 2957-2963.
16. Alm A, Stjernschantz J. Latanoprost administered once daily caused a maintained reduction of intraocular pressure in glaucoma patients treated concomitantly with timolol. Br J Ophthalmol, 1995, 79(1): 12-16.
17. Camras CB, the United States latanoprost Study Group. Comparison of latanoprost and timolol in patients with ocular hypertension and glaucoma: a six-month masked, multicenter trial in the United States.Ophthalmology, 1996, 103: 138-147.
18. Watson P, Stjernschantz J, the latanoprost Study Group. A six-month, randomized, double-masked study comparing latanoprost with timolol in open-angle glaucoma and ocular hypertension.Ophthalmology, 1996, 103: 126-137.
19. Fristr?m B. A 6-month, randomized, double-masked comparison of latanoprost with timolol in patients with open angle glaucoma or ocular hypertension. Acta Ophthalmol Scand, 1996, 74(2): 140-144.
20. Perry CM, McGavin JK. Latanoprost: an update of its use in glaucoma and ocular hypertension. Drugs Aging, 2003, 20(8): 597-630.
21. 彭大偉, 李紹珍, 等. latanoprost 與噻嗎心安治療開角型青光眼及高眼壓癥的臨床對照研究. 中華眼科雜志, 2000, 36(4): 285-288.
22. Hitchings RA. Primary surgery for primary open angle glaucoma--justified or not? Br J Ophthalmol, 1993, 77: 445-448.
23. Jay JL. Rational choice of therapy in primary open angle glaucoma. Eye(Lond), 1992, 6: 243-247.
24. 葉天才, 張秀蘭, 等. 非穿透性小梁手術聯合透明質酸植入物治療開角型青光眼. 中華眼科雜志, 2001, 37(4): 273-277.
25. Burr J, Azuara-Blanco A, Avenell A. Medical versus surgical interventions for open angle glaucoma. Cochrane Database Syst Rev, 2005, 18(2).
26. Webers CA, van der Valk R, Schouten JS, et al. Intraocular pressure-lowering effect of adding dorzolamide or latanoprost to timolol: a meta-analysis of randomized clinical trials. Ophthalmology, 2007, 114(1): 40-46.
27. Lesk MR, Koulis T, Sampalis F, et al. Effectiveness and safety of dorzolamide-timolol alone or combined with latanoprost in open-angle glaucoma or ocular hypertension. Ann Pharmacother, 2008, 42(4): 498-504.
28. Hodgew G, Lachaine J, Steffensen I, et al. The efficacy and harm of prostaglandin analogues for IOP reduction in glaucoma patient compared to dorzolaminde and brimonidine: a systematic review. Br J Ophthalmol, 2008, 92(1): 7-12.
29. 梅麗克木?艾山, 具爾提?哈德爾. 多佐胺和噻嗎洛爾聯用與拉坦前列腺素比較治療開角型青光眼的系統評價. 中國循證醫學雜志, 2009, 9(3): 350-354.

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《中國循證醫學雜志》

一例初診開角型青光眼患者的循證治療

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