Radcliffe Nathan M
Ophthalmology, New York University, New York, NY, USA.
Clin Ophthalmol. 2014 Dec 12;8:2541-9. doi: 10.2147/OPTH.S76053. eCollection 2014.
Glaucomatous optic atrophy is the second most common cause of blindness worldwide, and lowering intraocular pressure (IOP) is the only proven method to slow or stop the progression of the disease. Approximately 40% of patients with elevated IOP will require more than one medication to obtain a modest 20% reduction in IOP, and as a result, some patients may require two medications, provided in either two separate bottles or in one bottle with the use of fixed-combination therapies. Each therapy has its own unique safety and efficacy profile. Topical beta-blockers have a particularly favorable ocular-tolerability profile, and several studies of fixed-combination medications containing the beta-blocker timolol maleate have shown a lower prevalence of some ocular adverse events for the fixed-combination therapy compared to the non-beta-blocker individual component. In this review, we examined clinical data pertaining to the ocular surface tolerability of fixed-combination medications containing timolol maleate in comparison to the individual components. In particular, preference was given to prospective, randomized, multicenter trials of 3 months in duration or longer that compared a fixed-combination therapy to monotherapy with the individual components. A review of the literature revealed that some fixed-combination therapies can provide a reduced risk of common side effects compared to their individual components, with conjunctival hyperemia and ocular allergy being less frequent in some timolol-containing fixed-combination therapies. This effect appears to be most significant for latanoprost 0.005%, bimatoprost 0.03%, and brimonidine 0.2%.
青光眼性视神经萎缩是全球第二大致盲原因，降低眼压（IOP）是减缓或阻止该疾病进展的唯一已证实方法。约40%眼压升高的患者需要使用不止一种药物才能使眼压适度降低20%，因此，一些患者可能需要两种药物，可分别装在两个瓶子里，也可使用固定复方疗法装在一个瓶子里。每种疗法都有其独特的安全性和疗效特征。局部β受体阻滞剂具有特别良好的眼耐受性特征，多项关于含有马来酸噻吗洛尔的固定复方药物的研究表明，与非β受体阻滞剂单一成分相比，固定复方疗法某些眼部不良事件的发生率较低。在本综述中，我们研究了与含有马来酸噻吗洛尔的固定复方药物相比，其单一成分的眼表耐受性相关的临床数据。特别是，优先选择为期3个月或更长时间的前瞻性、随机、多中心试验，这些试验将固定复方疗法与单一成分的单药疗法进行了比较。文献综述显示，一些固定复方疗法与单一成分相比，可降低常见副作用的风险，在一些含噻吗洛尔的固定复方疗法中，结膜充血和眼部过敏的发生率较低。这种效果在0.005%拉坦前列素、0.03%比马前列素和0.2%溴莫尼定的疗法中似乎最为显著。
