目的 探讨毛果芸香碱联合拉坦前列素治疗原发性急性闭角型青光眼的疗效及安全性。方法 随机选取2014年5月—2015年1月海南医学院附属医院眼科收治的原发性急性闭角型青光眼患者92例,随机分为对照组和治疗组,每组各46例。对照组给予拉坦前列素滴眼液,1滴/次,1次/d。治疗组在对照组的基础上给药5 min后滴加硝酸毛果芸香碱滴眼液,2~3滴/次,2~4次/d。两组均连续治疗6个月。观察两组的临床疗效,同时比较两组患者治疗前后的视力、瞳孔直径、眼压、血流动力学指标舒张末期血流速度(EDV)、收缩期峰值血流速度(PSV)、血管阻力指数(RI)及不良反应。结果 治疗后,对照组和治疗组的总有效率分别为82.61%、95.65%,两组比较差异有统计学意义(P<0.05)。治疗1、3、6个月,两组患者的患眼视力、瞳孔直径均较同组治疗前显著改善,同组治疗前后差异具有统计学意义(P<0.05);且治疗后,治疗组患者的视力、瞳孔直径改善程度明显优于同期对照组,两组比较差异具有统计学意义(P<0.05)。对照组治疗3、6个月,治疗组治疗1、3、6个月的眼压与同组治疗前相比均有显著下降,且治疗组患者眼压下降情况明显优于同期对照组(P<0.05);治疗1、3、6个月,治疗组患者的EDV、PSV均明显高于对照组,而RI则明显低于对照组,同组治疗前后差异有统计学意义(P<0.05);且治疗组的改善程度优于对照组,两组比较差异有统计学意义(P<0.05)。对照组和治疗组的不良反应发生率分别为10.87%、0.00%,两组比较差异有统计学意义(P<0.05)。结论 毛果芸香碱联合拉坦前列素治疗原发性急性闭角型青光眼疗效显著,可明显改善视力,有效提高视野,降低眼压,安全性高,具有一定的临床推广应用价值。

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.