Sabri Kourosh, Levin Alex V
Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
J AAPOS. 2006 Oct;10(5):464-8. doi: 10.1016/j.jaapos.2006.07.001.
The effect of adding oral to topical carbonic anhydrase inhibitors in the management of pediatric glaucoma is unknown.
We undertook a retrospective analysis of children with a diagnosis of glaucoma before the age of 16 years who initially were treated with topical dorzolamide or dorzolamide-timolol combination and then treated with oral acetazolamide. Children who had uveitic glaucoma or who had ocular surgery within 3 months before or during oral acetazolamide therapy were excluded. Various methods of intraocular pressure (IOP) measurement were used in the study. However, in each case, the IOP was measured using the same technique, once at the last visit before the addition of oral acetazolamide and once at the first examination after the addition of oral acetazolamide.
Twenty-two patients were included in the study with an age range of 8 months to 15 years. Seventeen children were boys. Oral acetazolamide treatment was via a daily dose (13.3 to 30 mg/kg, mean 22.5 mg/kg), and duration (6 to 31 days, mean 18.1 days). The intraocular pressure (mean +/- SD) before acetazolamide (32.2 +/- 6.5 mm Hg) was significantly different than after acetazolamide (21.8 +/- 6.3 mm Hg) with a mean difference of 10.36 mm Hg (p < 0.0001) and a mean decrease in IOP of 29.6%.
The addition of oral acetazolamide to topical dorzolamide may provide additional reduction in IOP in some children already being treated with topical carbonic anhydrase inhibitors. This possible additive effect has not been observed in adults treated with a combination of topical and systemic carbonic anhydrase inhibitors.
在儿童青光眼治疗中，添加口服碳酸酐酶抑制剂至局部用药的效果尚不清楚。
我们对16岁前诊断为青光眼的儿童进行了一项回顾性分析，这些儿童最初接受局部用多佐胺或多佐胺 - 噻吗洛尔联合治疗，随后接受口服乙酰唑胺治疗。排除葡萄膜炎性青光眼患者或在口服乙酰唑胺治疗前3个月内或治疗期间进行过眼科手术的患者。研究中使用了多种眼压（IOP）测量方法。然而，在每种情况下，眼压均使用相同技术测量，一次在添加口服乙酰唑胺前的最后一次就诊时测量，一次在添加口服乙酰唑胺后的首次检查时测量。
22名患者纳入研究，年龄范围为8个月至15岁。17名儿童为男孩。口服乙酰唑胺治疗的日剂量为（13.3至30mg/kg，平均22.5mg/kg），疗程为（6至31天，平均18.1天）。乙酰唑胺治疗前的眼压（平均±标准差）为（32.2±6.5mmHg），与治疗后的眼压（21.8±6.3mmHg）有显著差异，平均差值为10.36mmHg（p<0.0001），眼压平均降低29.6%。
在已经接受局部碳酸酐酶抑制剂治疗的一些儿童中，添加口服乙酰唑胺至局部用多佐胺可能会进一步降低眼压。在接受局部和全身碳酸酐酶抑制剂联合治疗的成人中未观察到这种可能的相加作用。
