Department of Ophthalmology, University of Florida College of Medicine, Florida, USA.
Indian J Ophthalmol. 2023 Oct;71(10):3357-3360. doi: 10.4103/IJO.IJO_175_23.
Intraocular pressure (IOP) is the main modifiable risk factor for glaucoma. Current therapies target the anterior outflow of aqueous humor or its production. This study aims to demonstrate eplerenone could reduce IOP through a possible posterior outflow path via retinal pigment epithelium (RPE).
In this retrospective study, IOP changes in patients undergoing eplerenone treatment were investigated. Inclusion criteria were IOP data immediately before and during treatment. Exclusion criteria included ophthalmic procedures, changes in topical glaucoma treatment, or taking systemic medications affecting IOP. After reviewing 162 charts, 41 subjects were eligible. Pearson correlation test was used to investigate the correlation between continuous IOP and eplerenone dosage.
The mean ± SD IOP before eplerenone treatment was 14.31 ± 3.73 mmHg and decreased to 13.50 ± 4.04 mmHg; however, this was not statistically significant (P = 0.39). In subset of patients with eplerenone dose of more than 25 mg/day and baseline IOP equal to or less than 15 mmHg, the mean IOP before eplerenone treatment was 12.33 ± 2.59 mmHg and decreased to 10.33 ± 2.99, which is a trend toward IOP reduction with a 16% reduction in IOP (P = 0.055).
A possible dose-dependent decrease in IOP with eplerenone provides indirect evidence for the posterior flow model and suggests the mineralocorticoid receptors (MRs) in RPE play a role in the posterior flow of aqueous humor. It can be deduced that the RPE pumps responsible for the posterior flow of aqueous humor are MR-regulated and their function can be enhanced with MR antagonists.
眼内压（IOP）是青光眼的主要可调节风险因素。目前的治疗方法针对房水的前流出或其产生。本研究旨在通过视网膜色素上皮（RPE）的可能后流出途径证明依普利酮可降低 IOP。
在这项回顾性研究中，研究了接受依普利酮治疗的患者的 IOP 变化。纳入标准为治疗前后的 IOP 数据。排除标准包括眼科手术、局部青光眼治疗的改变或服用影响 IOP 的全身药物。在审查了 162 份图表后，有 41 名患者符合条件。使用 Pearson 相关检验来研究连续 IOP 与依普利酮剂量之间的相关性。
依普利酮治疗前的平均 ± SD IOP 为 14.31 ± 3.73 mmHg，并降至 13.50 ± 4.04 mmHg；然而，这在统计学上并不显著（P = 0.39）。在依普利酮剂量超过 25 mg/天且基线 IOP 等于或低于 15 mmHg 的患者亚组中，依普利酮治疗前的平均 IOP 为 12.33 ± 2.59 mmHg，并降至 10.33 ± 2.99 mmHg，这表明 IOP 有降低趋势，IOP 降低 16%（P = 0.055）。
依普利酮可能存在剂量依赖性的 IOP 降低，为后向流动模型提供了间接证据，并表明 RPE 中的盐皮质激素受体（MRs）在房水的后向流动中起作用。可以推断，负责房水后向流动的 RPE 泵受 MR 调节，其功能可以通过 MR 拮抗剂增强。
