School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada.
Oklahoma College of Optometry, Northeastern State University, Tahlequah, OK, USA.
Clin Exp Optom. 2021 Apr;104(3):350-366. doi: 10.1080/08164622.2021.1877529. Epub 2021 Mar 16.
Glaucoma is the most common form of irreversible blindness in the world. Lowering intraocular pressure (IOP) remains the only clinically established method of treatment to slow the progression of glaucoma. Primary open angle glaucoma is a disease of the optic nerve head and often is associated with changes to the trabecular meshwork that cause a reduction to aqueous humour outflow and an increase in intraocular pressure. Until recently, topical IOP lowering medication has been limited to the mechanisms of action of decreasing aqueous production and/or redirecting outflow to the unconventional uveoscleral outflow pathway. Both of these mechanisms neglect to treat or act on tissue that becomes altered from glaucoma. Latanoprostene-bunod 0.024%, a nitric-oxide donating prostanoid, netarsudil 0.02%, a potent Rho-associated protein kinase (ROCK) inhibitor and norepinephrine transporter inhibitor, and a once daily dosed fixed combination medication with netarsudil 0.02% and latanoprost 0.005% have recently come on the market. This paper will discuss and review the limitations to traditional IOP lowering glaucoma medications as well as the mechanism of actions and clinical efficacy of the new glaucoma medications. It will also discuss how the new class of glaucoma medications might help to overcome some known limitations in treatment and barriers to patient adherence.
青光眼是世界上最常见的不可逆盲眼病。降低眼内压（IOP）仍然是治疗减缓青光眼进展的唯一临床确立的方法。原发性开角型青光眼是一种视神经头部疾病，通常与小梁网的变化有关，这些变化导致房水流出减少和眼内压升高。直到最近，局部降眼压药物的作用机制一直局限于减少房水产生和/或重新引导流出到非传统的葡萄膜巩膜流出途径。这两种机制都忽略了治疗或作用于因青光眼而改变的组织。拉坦前列素苯丁醇 0.024%，一种一氧化氮供体前列腺素，奈他舒地尔 0.02%，一种有效的 Rho 相关蛋白激酶（ROCK）抑制剂和去甲肾上腺素转运蛋白抑制剂，以及一种每天一次给药的固定组合药物，含有奈他舒地尔 0.02%和拉坦前列素 0.005%，最近已上市。本文将讨论和回顾传统降眼压青光眼药物的局限性，以及新的青光眼药物的作用机制和临床疗效。它还将讨论新一类青光眼药物如何帮助克服治疗中的一些已知局限性和患者依从性的障碍。
