目的 探讨难治性青光眼应用复明片联合拉坦前列素治疗的临床效果。方法 选取2015年10月-2018年10月孝感市中心医院收治的100例（187眼）难治性青光眼患者，随机分成对照组（n=50，94眼）和治疗组（n=50例，3眼）。对照组予以拉坦前列素滴眼液，1滴/次，1次/d，于每日晚间滴入患眼。治疗组在对照组基础上口服复明片，5片/次，3次/d。两组均连续治疗12周。比较两组降眼压疗效，治疗前后最佳矫正视力及相关24 h眼压参数值、视野指标[平均敏感度（MS）、平均缺损（MD）、丢失方差（LV）]、眼动脉血流动力学参数[收缩期峰值流速（PSV）、舒张末期流速（EDV）、血流阻力系数（RI）]值和视功能相关生存质量量表-25（NEI VFQ-25）评分变化。结果 治疗后，对照组和治疗组的总有效率分别是71.3%、83.9%，两组比较差异有统计学意义（P<0.05）。两组治疗后最佳矫正视力的频数分布均显著优于治疗前（P<0.05）；但治疗后，治疗组最佳矫正视力的频数分布较对照组同期显著更优（P<0.05）。两组治疗后24 h眼压相关参数（峰值、平均值、波动值）均显著降低（P<0.05）；且治疗组以上24 h眼压相关参数值下降更显著（P<0.05）。治疗组治疗后视野MS值较治疗前显著增高，MD、LV值则均显著减小（P<0.05）；但治疗前后对照组上述视野指标变化均不明显。治疗组治疗后眼动脉PSV、EDV值均显著高于治疗前，而RI值显著降低（P<0.05）；治疗后，治疗组眼动脉血流动力学参数明显优于对照组（P<0.05）。但对照组治疗前后以上眼动脉血流动力学参数（PSV、EDV、RI）值亦均无明显改变。两组治疗后NEI VFQ-25评分均显著低于治疗前（P<0.05），而治疗组下降更显著（P<0.05）。结论 复明片联合拉坦前列素治疗难治性青光眼有助于维持患者眼压稳定，提高视力，改善视野损害及眼部血流动力学，提高患者生命质量，具有一定的临床推广应用价值。

Objective To investigate the clinical effect of Fuming Tablets combined with latanoprost in treatment of refractory glaucoma. Methods 100 Patients (187 eyes) with refractory glaucoma admitted to Xiaogan Central Hospital from October 2015 to October 2018 were randomly divided into control group (n=50 cases, 94 eyes) and treatment group (n=50 cases, 93 eyes). Patients in the control group were given Latanoprost Eye Drops, 1 drop/time, once daily, dropped into the affected eye every night. Patients in the treatment group were po administered with Fuming Tablets on the basis of the control group, 5 tablets/time, three times daily. All patients were treated for 12 weeks. The IOP lowering effects of the two groups were compared. The best corrected visual acuity and related 24 h IOP parameter values, visual field indexes[mean sensitivity (MS), mean defect (MD), loss variance (LV)], ophthalmic artery hemodynamic parameters[systolic peak flow rate (PSV), end diastolic flow rate (EDV), blood flow resistance coefficient (RI)], and NEI VFQ-25 score in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups was 71.3% and 83.9%, respectively, and there were differences between two groups (P<0.05). The frequency distribution of best corrected visual acuity after treatment in both groups was significantly better than that before treatment (P<0.05). However, after treatment, the frequency distribution of the best corrected visual acuity in the treatment group was significantly better than that in the control group (P<0.05). Compared with that before treatment, the IOP related parameters (peak value, average value and fluctuation value) of the two groups were significantly reduced 24 h after treatment (P<0.05). In addition, the IOP-related parameters decreased more significantly in the treatment group over 24 h (P<0.05). After treatment, the visual field MS value in the treatment group was significantly higher than that before treatment (P<0.05), while MD and LV values were significantly decreased (P<0.05). However, the changes of the above visual field indexes in the control group were not significant before and after treatment. After treatment, PSV and EDV values of ophthalmic artery in treatment group were significantly higher than before treatment (P<0.05), while RI values were significantly lower (P<0.05). After treatment, the mechanical parameters of ocular arterial blood flow in the treatment group were significantly better than those in the control group (P<0.05). However, the hemodynamic parameters (PSV, EDV, RI) of the above ophthalmic artery in the control group did not change significantly before and after treatment. After treatment, NEI VFQ-25 score in both groups was significantly lower than that before treatment (P<0.05), while that in the treatment group was significantly lower (P<0.05). Conclusion Fuming Tablets cmbined with ltanoprost in treatment of refractory glaucoma has a significant overall effect in the treatment of refractory glaucoma, and can effectively reduce the intraocular pressure of patients and maintain the relative stability of intraocular pressure, improve visual function such as vision and visual field, correct ocular hemodynamic abnormalities, improve the life quality of patients, which has a certain clinical application value.

R988.1