Costa Vital P, Harris Alon, Stefánsson Einar, Flammer Josef, Krieglstein Gunter K, Orzalesi Nicola, Heijl Anders, Renard Jean-Paul, Serra Luis Metzner
Glaucoma Service, University of Campinas, Rua Bauru, 40, São Paulo 01248-010, Brazil.
Prog Retin Eye Res. 2003 Nov;22(6):769-805. doi: 10.1016/s1350-9462(03)00064-8.
Based on the body of evidence implicating ocular blood flow disturbances in the pathogenesis of glaucoma, there is great interest in the investigation of the effects of antiglaucoma drugs and systemic medications on the various ocular vascular beds. The primary aim of this article was to review the current data available on the effects of antiglaucoma drugs and systemic medications on ocular blood flow. We performed a literature search in November 2002, which consisted of a textword search in MEDLINE for the years 1968-2002. The results of this review suggest that there is a severe lack of well-designed long-term studies investigating the effects of antiglaucoma and systemic medications on ocular blood flow in glaucomatous patients. However, among the 136 articles dealing with the effect of antiglaucoma drugs on ocular blood flow, only 36 (26.5%) investigated the effects of medications on glaucoma patients. Among these 36 articles, only 3 (8.3%) were long-term studies, and only 16 (44.4%) were double-masked, randomized, prospective trials. Among the 33 articles describing the effects of systemic medications on ocular blood flow, only 11 (33.3%) investigated glaucoma patients, of which only one (9.1%) was a double-masked, randomized, prospective trial. Based on this preliminary data, we would intimate that few antiglaucoma medications have the potential to directly improve ocular blood flow. Unoprostone appears to have a reproducible antiendothelin-1 effect, betaxolol may exert a calcium-channel blocker action, apraclonidine consistently leads to anterior segment vasoconstriction, and carbonic anhydrase inhibitors seem to accelerate the retinal circulation. Longitudinal, prospective, randomized trials are needed to investigate the effects of vasoactive substances with no hypotensive effect on the progression of glaucoma.
基于大量证据表明眼部血流紊乱在青光眼发病机制中起作用，人们对研究抗青光眼药物和全身用药对各种眼部血管床的影响产生了浓厚兴趣。本文的主要目的是综述目前关于抗青光眼药物和全身用药对眼部血流影响的现有数据。我们于2002年11月进行了文献检索，包括在MEDLINE中对1968 - 2002年进行文本词检索。该综述结果表明，严重缺乏精心设计的长期研究来调查抗青光眼药物和全身用药对青光眼患者眼部血流的影响。然而，在136篇关于抗青光眼药物对眼部血流影响的文章中，仅有36篇（26.5%）研究了药物对青光眼患者的影响。在这36篇文章中，仅有3篇（8.3%）是长期研究，仅有16篇（44.4%）是双盲、随机前瞻性试验。在33篇描述全身用药对眼部血流影响的文章中，仅有11篇（33.3%）研究了青光眼患者，其中仅有1篇（9.1%）是双盲、随机前瞻性试验。基于这些初步数据，我们认为很少有抗青光眼药物有直接改善眼部血流的潜力。乌诺前列酮似乎具有可重复的抗内皮素 - 1作用，倍他洛尔可能发挥钙通道阻滞剂作用，阿可乐定持续导致眼前节血管收缩，碳酸酐酶抑制剂似乎能加速视网膜循环。需要进行纵向、前瞻性、随机试验来研究无降压作用的血管活性物质对青光眼进展的影响。
