Pandey Achyut N, Sujata S
Department of Ophthalmology, VCSG Medical College and Research Institute, Srinagar Garhwal, Uttarakhand 246174, India.
Joseph Eye Hospital, Trichy, Tamilnadu 426001, India.
Int J Ophthalmol. 2014 Feb 18;7(1):128-32. doi: 10.3980/j.issn.2222-3959.2014.01.24. eCollection 2014.
Prospectively analyze the long term structural and functional changes in patients of primary open angle glaucoma (POAG) receiving medical therapy (beta blockers and non beta blockers). In this study an attempt has been made to evaluate whether medical reduction of IOP prevents or delays the progression of glaucomatous visual field loss and/or optic nerve damage in patients with open angle glaucoma.
Study conducted over a period of 27 months, at a tertiary eye care hospital including both eyes of 40 patients with POAG. Group 1 (20 patients, 40 eyes) received beta-blockers, and Group 2 (20 patients, 40 eyes) received non-beta-blockers. Each patient underwent intraocular pressure measurement, best corrected visual acuity, slit-lamp, fundus examination, gonioscopy, central corneal thickness, visual field assessment by Humphrey automated perimetry and retinal nerve fibre layer thickness by Stratus optical coherence tomography at baseline and at two subsequent visits. The average time interval between each visit was 10-11 months. The statistical analysis was done using one-way analysis of variance (ANOVA). Post-hoc test, using tukey' method were adopted. Probablity (P) value of 0.05 or less was considered to be statistically significant.
A total of 80 eyes of 40 patients of POAG were enrolled, 24 males, 16 females, age group 50-80 years. In both beta and non beta blocker group, reduction (improvement) in mean IOP from initial levels to the levels achieved at the 2nd and 3rd visits was statistically significant. One way ANOVA (df=2), fisher f value=11.64, P=0.000, one way ANOVA (df=3), fisher f value=35.61, P=0.000. Both mean deviation (MD) and pattern standard deviation (PSD) in both beta and non beta blockers at different visits were not statistically significant. Retinal nerve fibre layer thickness (RNFL) -only mean inferior retinal nerve fibre layer, the difference between the mean value in beta and non beta blocker groupwere statistically significant. [unpaired t test value (df=78) =2.27, P=0.03]. Side effects with beta blocker were conjunctival hyperemia (10%), burning (5%), and conjunctival hyperemia (5%) in non beta blockers.
Non-beta-blockers are as effective as beta-blockers in bringing about a significant lowering of intraocular pressure to the normal range, and in preventing progressive damage to the visual fields and retinal nerve fibre layer. The absence of systemic side effects and superior IOP lowering efficacy has made non beta-blockers attractive for first line therapy for the treatment of glaucoma worldwide.
前瞻性分析接受药物治疗（β受体阻滞剂和非β受体阻滞剂）的原发性开角型青光眼（POAG）患者的长期结构和功能变化。在本研究中，试图评估眼压的药物降低是否能预防或延缓开角型青光眼患者青光眼性视野缺损和/或视神经损伤的进展。
在一家三级眼科护理医院进行了为期27个月的研究，纳入40例POAG患者的双眼。第1组（20例患者，40只眼）接受β受体阻滞剂，第2组（20例患者，40只眼）接受非β受体阻滞剂。每位患者在基线以及随后的两次随访时均接受眼压测量、最佳矫正视力、裂隙灯检查、眼底检查、前房角镜检查、中央角膜厚度、通过Humphrey自动视野计进行视野评估以及通过Stratus光学相干断层扫描测量视网膜神经纤维层厚度。每次随访之间的平均时间间隔为10 - 11个月。采用单因素方差分析（ANOVA）进行统计分析。采用tukey法进行事后检验。概率（P）值小于或等于0.05被认为具有统计学意义。
共纳入40例POAG患者的80只眼，其中男性24例，女性16例，年龄在50 - 80岁之间。在β受体阻滞剂组和非β受体阻滞剂组中，平均眼压从初始水平降至第2次和第3次随访时达到的水平的降低（改善）具有统计学意义。单因素方差分析（自由度 = 2），费舍尔F值 = 11.64，P = 0.000；单因素方差分析（自由度 = 3），费舍尔F值 = 35.61，P = 0.000。在不同随访时，β受体阻滞剂组和非β受体阻滞剂组的平均偏差（MD）和模式标准偏差（PSD）均无统计学意义。视网膜神经纤维层厚度（RNFL）——仅平均下方视网膜神经纤维层，β受体阻滞剂组和非β受体阻滞剂组的平均值差异具有统计学意义。[未配对t检验值（自由度 = 78） = 2.27，P = 0.03]。β受体阻滞剂的副作用为结膜充血（10%）、烧灼感（5%），非β受体阻滞剂的副作用为结膜充血（5%）。
非β受体阻滞剂在使眼压显著降低至正常范围以及预防视野和视网膜神经纤维层的进行性损伤方面与β受体阻滞剂同样有效。无全身副作用以及更好的眼压降低效果使得非β受体阻滞剂成为全球青光眼一线治疗的有吸引力的选择。
