Parentin Fulvio
Department of Ophthalmology, 'Burlo Garofolo' Hospital, Trieste, Italy.
Ocul Immunol Inflamm. 2003 Mar;11(1):67-71. doi: 10.1076/ocii.11.1.67.15580.
To describe a previously unreported case of anterior granulomatous uveitis in a patient using bimatoprost.
A 72-year-old woman with a long-standing history of anisometropic amblyopia and pseudoexfoliative glaucoma in the right eye started therapy with bimatoprost 0.03% once a day in the right eye. She had no previous history of ocular inflammation or ocular surgery. Her medical history was negative for systemic diseases associated with ocular inflammation.
After one week, the patient developed severe conjunctival injection, cells and flare, and numerous 'mutton fat' keratic precipitates in the right eye. Examination of the left eye revealed no evidence of inflammation. Bimatoprost was discontinued; no topical steroid therapy was started. Systemic investigations were normal. The inflammation resolved over two weeks, solely with the discontinuation of bimatoprost.
Bimatoprost is a synthetic prostamide, chemically related to prostamide F. Prostamides are naturally occurring substances, biosynthesized from anandamide in a pathway that includes COX2. Even though anandamide has proven suggestive potential pro-inflammatory effects, the mechanism of induction of inflammation by bimatoprost remains uncertain and speculative. In our report, the onset of acute uveitis in a patient using bimatoprost, after a long-term and well-tolerated treatment with a prostaglandin analog, suggests a distinct potential pro-inflammatory action of prostamides. This can indirectly support the concept that the target receptor of bimatoprost is different, and that the mechanism of action of prostamides is pharmacologically unique.
描述一例使用比马前列素的患者发生的此前未报告的前葡萄膜炎病例。
一名72岁女性，右眼有长期不等轴性弱视和假性剥脱性青光眼病史，开始右眼每天一次使用0.03%比马前列素治疗。她既往无眼部炎症或眼部手术史。其病史中无与眼部炎症相关的全身性疾病。
一周后，患者右眼出现严重结膜充血、细胞和闪光，以及大量“羊脂状”角膜后沉着物。左眼检查未发现炎症迹象。停用比马前列素；未开始局部类固醇治疗。全身检查正常。仅通过停用比马前列素，炎症在两周内消退。
比马前列素是一种合成前列腺酰胺，与前列腺酰胺F化学相关。前列腺酰胺是天然存在的物质，由花生四烯乙醇胺通过包括COX2的途径生物合成。尽管花生四烯乙醇胺已被证明有潜在的促炎作用，但比马前列素诱发炎症的机制仍不确定且具有推测性。在我们的报告中，一名患者在长期耐受前列腺素类似物治疗后使用比马前列素发生急性葡萄膜炎，提示前列腺酰胺有独特的潜在促炎作用。这可以间接支持比马前列素的靶受体不同以及前列腺酰胺的作用机制在药理学上独特的观点。
