Zimmerman T J, Sharir M, Nardin G F, Fuqua M
Department of Ophthalmology and Visual Sciences, University of Louisville, School of Medicine, Kentucky 40292.
Am J Ophthalmol. 1992 Jul 15;114(1):1-7. doi: 10.1016/s0002-9394(14)77404-5.
We assessed the effect of nasolacrimal occlusion on the therapeutic index of various antiglaucoma medications in healthy volunteers and patients with glaucoma. Nasolacrimal occlusion used with pilocarpine 2% every 12 hours gave the maximal ocular hypotensive response. Carbachol 1.5% every 12 hours with nasolacrimal occlusion gave the maximal response for this drug. For timolol, nasolacrimal occlusion collapsed the dose-response curve and extended the duration of action. A final trial of carbachol added to timolol with nasolacrimal occlusion showed that timolol 0.25% and carbachol 1.5% every 12 hours gave the maximal response for this combination. Our findings suggest that most of the commercially used ocular hypotensive agents can achieve the same maximal effect with lower concentrations and less frequent administration (never exceeding every 12 hours) than are currently recommended should nasolacrimal occlusion be performed. Furthermore, nasolacrimal occlusion should markedly decrease the systemic absorption of topical ocular drugs and lessen the chance of systemic side effects.
我们评估了鼻泪管阻塞对健康志愿者和青光眼患者中各种抗青光眼药物治疗指数的影响。每12小时使用2%毛果芸香碱并联合鼻泪管阻塞可产生最大的眼压降低反应。每12小时使用1.5%卡巴胆碱并联合鼻泪管阻塞可使该药物产生最大反应。对于噻吗洛尔，鼻泪管阻塞使剂量反应曲线变平坦并延长了作用持续时间。最后一项在鼻泪管阻塞情况下将卡巴胆碱添加到噻吗洛尔中的试验表明，每12小时使用0.25%噻吗洛尔和1.5%卡巴胆碱可使该组合产生最大反应。我们的研究结果表明，与目前推荐的用药浓度和给药频率（从不超过每12小时一次）相比，如果进行鼻泪管阻塞，大多数市售的降眼压药物可以用更低的浓度和更少的给药频率（从不超过每12小时一次）达到相同的最大效果。此外，鼻泪管阻塞应可显著减少局部眼用药物的全身吸收，并降低出现全身副作用的几率。
