Rosenberg L F, Krupin T, Tang L Q, Hong P H, Ruderman J M
Department of Ophthalmology, Northwestern University Medical School, Chicago, Illinois, USA.
Ophthalmology. 1998 Jan;105(1):88-92; discussion 92-3. doi: 10.1016/s0161-6420(98)91421-x.
The study aimed to determine whether topical dorzolamide and systemic acetazolamide have an additive effect on intraocular pressure (IOP) and aqueous humor formation (AHF).
This was a prospective, open-label, two-protocol clinical study.
Sixteen patients with ocular hypertension or with primary open-angle glaucoma were studied.
Baseline AHF was measured by computerized fluorophotometry and IOP by pneumatonometry without antiglaucoma therapy. In the first protocol, dorzolamide was randomized to one eye (N = 10) and IOP and AHF measurements were repeated. One week later, having used dorzolamide in one eye three times daily, patients had measurements performed before and after the single administration of oral acetazolamide 250 mg. In the second protocol, having used acetazolamide 250 mg four times daily for 4 to 7 days (N = 6), patients had measurements performed before and after a single drop of dorzolamide was instilled randomly into one eye. The patient continued acetazolamide and unilateral dorzolamide for 4 to 7 more days and returned for IOP and AHF measurements.
Intraocular pressure and AHF were measured in treated and contralateral control eyes.
In the first protocol, IOP (mmHg +/- standard deviation) was significantly (P = 0.02) lower in the dorzolamide (16.3 +/- 2.6) than in the contralateral control (19.9 +/- 2.9) eyes. Aqueous humor formation (microliter/minute +/- standard deviation) also was lower (P = 0.02) in dorzolamide eyes (1.79 +/- 0.4 vs. 2.33 +/- 0.5). After oral acetazolamide 250 mg, IOP was unchanged in dorzolamide eyes (17.6 +/- 2.0 preacetazolamide vs. 17.9 +/- 2.0 postacetazolamide), whereas it was reduced (P = 0.003) in control eyes (20.5 +/- 2.2 preacetazolamide vs. 16.9 +/- 2.3 postacetazolamide). Aqueous humor formation was reduced in control eyes (2.31 +/- 0.8 preacetazolamide vs. 1.73 +/- 0.6 postacetazolamide; P = 0.005) but not in dorzolamide-treated eyes (1.56 +/- 0.45 preacetazolamide vs. 1.77 +/- 0.39 postacetazolamide). In the second protocol, acetazolamide 250 mg four times daily symmetrically reduced IOP and AHF in both eyes. After single-drop dorzolamide in one eye, IOP and AHF did not change significantly. After 4 to 7 days of acetazolamide and unilateral dorzolamide, IOP and AHF remained reduced to a similar level in dorzolamide and control eyes not receiving topical therapy.
Topical dorzolamide and oral acetazolamide, in the concentrations and doses used in this study, are not additive. Either drug alone results in maximum reduction in IOP and AHF. Concomitant glaucoma therapy of a topical and systemic carbonic anhydrase inhibitor is not warranted.
本研究旨在确定局部用多佐胺和全身用乙酰唑胺对眼压（IOP）和房水生成（AHF）是否具有相加作用。
这是一项前瞻性、开放标签、双方案临床研究。
对16例高眼压症或原发性开角型青光眼患者进行了研究。
在未进行抗青光眼治疗的情况下，通过计算机荧光光度法测量基线AHF，通过眼压计测量IOP。在第一个方案中，将多佐胺随机分配至一只眼（N = 10），并重复测量IOP和AHF。一周后，在一只眼中每日3次使用多佐胺，患者在单次口服250 mg乙酰唑胺之前和之后进行测量。在第二个方案中，在6例患者中每日4次使用250 mg乙酰唑胺，持续4至7天，然后将一滴多佐胺随机滴入一只眼中，在用药前后进行测量。患者继续使用乙酰唑胺和单侧多佐胺4至7天，然后返回进行IOP和AHF测量。
在治疗眼和对侧对照眼中测量IOP和AHF。
在第一个方案中，多佐胺治疗眼的IOP（mmHg±标准差）显著低于对侧对照眼（16.3±2.6比19.9±2.9，P = 0.02）。多佐胺治疗眼的房水生成（微升/分钟±标准差）也较低（1.79±0.4比2.33±0.5，P = 0.02）。口服250 mg乙酰唑胺后，多佐胺治疗眼的IOP无变化（乙酰唑胺用药前17.6±2.0，用药后17.9±2.0），而对照眼的IOP降低（P = 0.003）（乙酰唑胺用药前20.5±2.2，用药后16.9±2.3）。对照眼的房水生成减少（乙酰唑胺用药前2.31±0.8，用药后1.73±0.6；P = 0.005），但多佐胺治疗眼未减少（乙酰唑胺用药前1.56±0.45，用药后1.77±0.39）。在第二个方案中，每日4次使用250 mg乙酰唑胺可使双眼的IOP和AHF对称降低。在一只眼中滴入一滴多佐胺后，IOP和AHF无显著变化。在使用乙酰唑胺和单侧多佐胺4至7天后，多佐胺治疗眼和未接受局部治疗的对照眼中的IOP和AHF仍降低至相似水平。
本研究中使用的浓度和剂量的局部用多佐胺和口服乙酰唑胺不具有相加作用。单独使用任何一种药物均可使IOP和AHF最大程度降低。不推荐同时使用局部和全身碳酸酐酶抑制剂进行青光眼治疗。
