Negri Letizia, Ferreras Antonio, Iester Michele
Anatomical-Clinical Laboratory for Functional Diagnosis and Treatment of Glaucoma and Neuro-ophthalmology, Eye Clinic, DiNOGMI, University of Genoa, Genoa, Italy.
Department of Ophthalmology, IIS-Aragon, Miguel Servet University Hospital, University of Zaragoza, Zaragoza, Spain.
J Ophthalmol. 2019 May 2;2019:4146124. doi: 10.1155/2019/4146124. eCollection 2019.
Glaucoma is a progressive, chronic optic neuropathy characterized by a typical visual field defects. Four main classes of topical medication are actually available on the market: beta-blockers, prostaglandins, alpha2-agonists, and topical carbonic anhydrase inhibitor to treat intraocular pressure (IOP). The aim of this review is to outline the efficacy of timolol and to evaluate the impact of this treatment on patients' quality of life. Among beta-blockers, timolol is most used at three different concentrations: 0.1%, 0.25%, and 0.5%. While the first one is a gel, the other two products are solution. Timolol has few topical side effects, while it has some important systemic side effects on the cardiac and respiratory systems. The balance between efficacy and safety is always the main aspect to care patients. Because of the less efficacy of timolol 0.1% solution, the possibility to use carbomers as vehicle in the gel drops helped timolol 0.1 to be used in clinics, extending the time contact between the active ingredient and the surface of the cornea. Using preservative-free timolol 0.1 for treatment, IOP was at the same level of the other beta-blockers at higher concentration, but it was better tolerated. Preservative-free treatment improved the quality of life reducing dry-eye like symptoms; furthermore, the presence of an artificial tear in the medication bottle could help adherence. The once daily dosing improves compliance.
青光眼是一种进行性慢性视神经病变，其特征为典型的视野缺损。目前市场上实际有四类主要的局部用药：β受体阻滞剂、前列腺素、α2激动剂和局部碳酸酐酶抑制剂，用于治疗眼压（IOP）。本综述的目的是概述噻吗洛尔的疗效，并评估这种治疗对患者生活质量的影响。在β受体阻滞剂中，噻吗洛尔以三种不同浓度最为常用：0.1%、0.25%和0.5%。第一种是凝胶剂，另外两种产品是溶液剂。噻吗洛尔局部副作用较少，但对心脏和呼吸系统有一些重要的全身副作用。疗效与安全性之间的平衡始终是照顾患者的主要方面。由于0.1%噻吗洛尔溶液的疗效较低，在凝胶滴眼液中使用卡波姆作为载体的可能性有助于0.1%噻吗洛尔在临床上的应用，延长了活性成分与角膜表面的接触时间。使用不含防腐剂的0.1%噻吗洛尔进行治疗时，眼压与其他高浓度β受体阻滞剂处于同一水平，但耐受性更好。不含防腐剂的治疗改善了生活质量，减轻了类似干眼的症状；此外，药瓶中含有人工泪液有助于提高依从性。每日一次给药提高了依从性。
