Vetrugno Michele, Sisto Dario, Trabucco Tiziana, Balducci Francesca, Delle Noci Nicola, Sborgia Carlo
Department of Ophthalmology and Otorhinolaringology, University of Bari, Bari, Italy.
J Ocul Pharmacol Ther. 2005 Jun;21(3):250-7. doi: 10.1089/jop.2005.21.250.
Reduction and diurnal stabilization of the intra-ocular pressure (IOP) is the mainstay of treatment for glaucoma. Fluctuations of IOP in glaucomatous patients can also be induced by the osmotic variations caused by water ingestion. Such influence can be studied by means of the water-drinking test (WDT). The aim of this study was to perform the WDT in patients with primary open-angle glaucoma (POAG) while they were being treated with different IOP-lowering medications, to test the effect of drugs with different mechanisms of action on the ability to maintain a stable IOP.
A total of 280 POAG patients were enrolled, 40 patients per group for each of the tested medications (timolol, dorzolamide, brinzolamide, travoprost,latanoprost, bimatoprost, and brimonidine). After baseline IOP measurement, all patients underwent WDT (1000 mL of water in 10 min). The IOP was measured at 15-min intervals until the return of IOP to baseline values. The main outcomes measured were mean IOP peak, mean IOP percentage increase, and mean time for returning to baseline IOP value.
The highest mean IOP peak was found with timolol, whereas no difference was found among the other drugs. The highest mean IOP percentage increase was found with timolol, whereas bimatoprost showed an IOP percentage increase significantly lower than latanoprost, dorzolamide, and brinzolamide. The duration of IOP increase was shortest for bimatoprost and longest for timolol.
This study suggests that topical medications that enhance outflow (e.g., bimatoprost, latanoprost, travoprost, and brimonidine) may provide, under stressful conditions such as the WDT, better IOP stabilization than medications that decrease aqueous humor inflow, such as timolol and topical carbonic anhydrase inhibitors.
降低并使眼压（IOP）在日间保持稳定是青光眼治疗的主要方法。青光眼患者的眼压波动也可由饮水引起的渗透压变化诱发。这种影响可通过饮水试验（WDT）进行研究。本研究的目的是在原发性开角型青光眼（POAG）患者接受不同降眼压药物治疗时进行WDT，以测试不同作用机制的药物对维持眼压稳定能力的影响。
共纳入280例POAG患者，每种受试药物（噻吗洛尔、多佐胺、布林佐胺、曲伏前列素、拉坦前列素、比马前列素和溴莫尼定）每组40例患者。在测量基线眼压后，所有患者均接受WDT（10分钟内饮用1000毫升水）。每隔15分钟测量一次眼压，直至眼压恢复到基线值。测量的主要结果包括平均眼压峰值、平均眼压升高百分比以及恢复到基线眼压值的平均时间。
噻吗洛尔的平均眼压峰值最高，而其他药物之间未发现差异。噻吗洛尔的平均眼压升高百分比最高，而比马前列素的眼压升高百分比显著低于拉坦前列素、多佐胺和布林佐胺。比马前列素眼压升高的持续时间最短，噻吗洛尔最长。
本研究表明，在诸如WDT等应激条件下，促进房水流出的局部用药（如比马前列素、拉坦前列素, 曲伏前列素和溴莫尼定）可能比减少房水生成的药物（如噻吗洛尔和局部碳酸酐酶抑制剂）能更好地稳定眼压。
