目的 探討毛果蕓香堿聯(lián)合拉坦前列素治療原發(fā)性急性閉角型青光眼的療效及安全性。方法 隨機(jī)選取2014年5月—2015年1月海南醫(yī)學(xué)院附屬醫(yī)院眼科收治的原發(fā)性急性閉角型青光眼患者92例,隨機(jī)分為對(duì)照組和治療組,每組各46例。對(duì)照組給予拉坦前列素滴眼液,1滴/次,1次/d。治療組在對(duì)照組的基礎(chǔ)上給藥5 min后滴加硝酸毛果蕓香堿滴眼液,2~3滴/次,2~4次/d。兩組均連續(xù)治療6個(gè)月。觀察兩組的臨床療效,同時(shí)比較兩組患者治療前后的視力、瞳孔直徑、眼壓、血流動(dòng)力學(xué)指標(biāo)舒張末期血流速度(EDV)、收縮期峰值血流速度(PSV)、血管阻力指數(shù)(RI)及不良反應(yīng)。結(jié)果 治療后,對(duì)照組和治療組的總有效率分別為82.61%、95.65%,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療1、3、6個(gè)月,兩組患者的患眼視力、瞳孔直徑均較同組治療前顯著改善,同組治療前后差異具有統(tǒng)計(jì)學(xué)意義(P<0.05);且治療后,治療組患者的視力、瞳孔直徑改善程度明顯優(yōu)于同期對(duì)照組,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。對(duì)照組治療3、6個(gè)月,治療組治療1、3、6個(gè)月的眼壓與同組治療前相比均有顯著下降,且治療組患者眼壓下降情況明顯優(yōu)于同期對(duì)照組(P<0.05);治療1、3、6個(gè)月,治療組患者的EDV、PSV均明顯高于對(duì)照組,而RI則明顯低于對(duì)照組,同組治療前后差異有統(tǒng)計(jì)學(xué)意義(P<0.05);且治療組的改善程度優(yōu)于對(duì)照組,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。對(duì)照組和治療組的不良反應(yīng)發(fā)生率分別為10.87%、0.00%,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論 毛果蕓香堿聯(lián)合拉坦前列素治療原發(fā)性急性閉角型青光眼療效顯著,可明顯改善視力,有效提高視野,降低眼壓,安全性高,具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To investigate the clinical effect and safety of pilocarpine combined with latanoprost in treatment of primary acute angle closure glaucoma. Methods Patients (92 cases) with primary acute angle closure glaucoma in Department of Ophthalmology from Affiliated Hospital of Hainan Medical University from May 2014 to January 2015 were randomly divided into control and treatment groups, and each group had 46 cases. The patients in the control group were given Latanoprost Eye Drops, 1 drop/time, once daily. The patients in the treatment group were given Pilocarpine Nitrate Eye Drops on the basis of control group after giving Latanoprost Eye Drops for 5 min, 2—3 drops/time, 2—4 times/d. The patients in two groups were treated for 6 months. The clinical efficacy was evaluated, and the eyesight of sick eyes, pupil diameter, ocular hypertension, hemodynamics indexes end-diastolic velocity (EDV), systolic peak flow velocity (PSV), and vascular resistance index (RI), and adverse reactions in two groups were compared before and after treatment. Results After treatment, the clinical efficacies in the control and treatment groups were 82.61% and 95.65%, respectively, and there were differences between two groups (P< 0.05). After treatment for 1, 3, and 6 months, eyesight of sick eyes and pupil diameter in two groups were significantly improved, and the difference was statistically significant in the same group (P< 0.05). After treatment, eyesight of sick eyes and pupil diameter in the treatment group were significantly better than those in the control group, with significant difference between two groups (P< 0.05). The ocular hypertension of patients in the control group after treatment for 3, and 6 months, and in the treatment group after treatment for 1, 3, and 6 months was significantly decreased. And the ocular hypertension in the treatment group was better than that in the control group, with significant difference between two groups (P< 0.05). After treatment for 1, 3, and 6 months, EDV and PSV in the treatment group was higher than that in the control group, and RI was lower than that in the control group, and the difference was statistically significant in the same group (P< 0.05). And the EDV, PSV, and RI in the treatment group were better than those in the control group with significant difference (P< 0.05). Conclusion Pilocarpine combined with latanoprost has clinical curative effect in treatment of primary acute angle closure glaucoma, and can obviously improve vision, and also can improve the field of vision with high safety, which has a certain clinical application value.