Detry-Morel M, De Hoste F
Cliniques Universitaires St. Luc, UCL, Bruxelles.
Bull Soc Belge Ophtalmol. 1997;267:157-66.
Clinical evaluation of the efficacy and innocuity of dorzolamide, the first new born topical carbonic anhydrase inhibitor.
Our retrospective analysis included 162 patients (76 men, 86 women) who were exclusively followed in our department and treated between June 96 and August 97 with dorzolamide (Trusopt 2%) administered in a minority of patients (n = 13) as the only hypotensive medication and in combination with other hypotensive drugs and/or as a substitute for acetazolamide or for miotics in the others (add on, n = 149). The mean age of the patients was 65.2 +/- 15.6 and the average follow up was 9.8 +/- 5.4 months. Dorzolamide was prescribed in various forms of glaucoma and ocular hypertension, mostly in POAG (n = 137). In bilateral treatments (n = 116/162), the eye with the most severe defect and/or the highest IOP was considered. IOP was checked along the other criteria generally followed in glaucoma patients at 1 and 3 months following the instauration of dorzolamide and then trimestrially. We considered as the initial IOP a mean value of the 2 most recent successive IOP values before instauration of dorzolamide realized at the same daytime. Patients with laser trabeculoplasty or cataract surgery during the dorzolamide treatment were disguarded.
All patients considered, the mean IOP reduction was from 21.5 mm Hg before to 19.3 mm Hg with dorzolamide at the last control. The mean IOP decrease was statistically significant and stable at all controls. The mean IOP reduction was 18.4% (4.2 mm Hg) in the monotherapy group and 12.5% (3 mm Hg) in the add on group. There were 15.3% non responders (mean IOP reduction < half of the average IOP decrease observed all patients confounded) in the monotherapy group and 26% in the add on group. Local tolerance of dorzolamide was excellent in 84%. About 15% of patients (25/162) complained of systemic side effects mostly comparable to the side effects of oral IAC. Treatment was stopped in 57 patients (35.2%) primarily due to allergic blepharoconjunctivitis (n = 12 or 7.4%), general intolerance (n = 14 or 8.6%) and insufficient IOP reduction (n = 26 or 16%).
Dorzolamide represents in our experience an effective ocular hypotensive drug but its systemic tolerance profile seems less promising than described in the literature.
对首个新型局部碳酸酐酶抑制剂多佐胺的疗效和安全性进行临床评估。
我们的回顾性分析纳入了162例患者（76例男性，86例女性），这些患者均在我们科室接受治疗，于1996年6月至1997年8月期间使用多佐胺（2%的Trusopt）进行治疗。少数患者（n = 13）将其作为唯一的降压药物，其他患者（n = 149）则与其他降压药物联合使用和/或作为乙酰唑胺或缩瞳剂的替代品（附加治疗）。患者的平均年龄为65.2±15.6岁，平均随访时间为9.8±5.4个月。多佐胺被用于各种形式的青光眼和高眼压症，主要是原发性开角型青光眼（n = 137）。在双侧治疗（n = 116/162）中，考虑病情最严重和/或眼压最高的眼睛。在使用多佐胺后的1个月和3个月，以及之后每三个月，按照青光眼患者通常遵循的其他标准检查眼压。我们将多佐胺使用前同一日间最近连续两次眼压值的平均值作为初始眼压。在多佐胺治疗期间接受激光小梁成形术或白内障手术的患者被排除。
所有患者中，末次检查时眼压均值从使用多佐胺前的21.5 mmHg降至19.3 mmHg。在所有检查中，眼压均值下降具有统计学意义且保持稳定。单药治疗组眼压平均降低18.4%（4.2 mmHg），附加治疗组为12.5%（3 mmHg）。单药治疗组有15.3%的患者治疗无效（眼压平均降低幅度小于所有患者平均降幅的一半），附加治疗组为26%。84%的患者对多佐胺的局部耐受性良好。约15%的患者（25/162）抱怨有全身副作用，大多与口服碳酸酐酶抑制剂的副作用相当。57例患者（35.2%）停止治疗，主要原因是过敏性睑结膜炎（n = 12或7.4%）、全身不耐受（n = 14或8.6%）和眼压降低不足（n = 26或16%）。
根据我们的经验，多佐胺是一种有效的降眼压药物，但其全身耐受性似乎不如文献中描述的那样乐观。
