Comparison of the hypotensor effect between latanoprost versus selective laser trabeculoplasty obtained with the water drinking test

ABSTRACT Purpose: Glaucoma is the main cause of irreversible blindness worldwide. Peak intraocular pressure is one of the main risk factors for glaucoma progression, and intraocular pressure reduction remains the only therapeutic strategy for all types of glaucoma. The main purpose of our study was to compare the baseline and peak intraocular pressure reduction obtained with the water drinking test between the two eyes of the same patients using 0.005% latanoprost in one eye and selective laser trabeculoplasty application in the contralateral eye. Methods: This was a prospective, interventional, longitudinal, and randomized clinical trial, in which 30 consecutive glaucomatous patients, medically controlled using latanoprost monotherapy, were recruited from a single ophthalmological center. The patients’ eyes were randomized, and one eye was selected for SLT treatment and topical 0.005% latanoprost was introduced in the contralateral eye. The baseline intraocular pressure and peak intraocular pressure were evaluated 1 month (water drinking test 2) and 6 months (water drinking test 3) after treatment. Results: There was no significant difference between the mean pre-washout intraocular pressure in the randomized eyes for selective laser trabeculoplasty and latanoprost (13.6 ± 2.1 and 13.3 ± 1.8 mmHg, respectively; p=0.182). Regarding baseline intraocular pressure, there was no significant difference in the water drinking test 2 (p=0.689) and water drinking test 3 (p=0.06) between the groups. There was no significant difference in the intraocular pressure peak between the SLT and latanoprost groups at water drinking test 2 (p=0.771) or water drinking test 3 (p=0.774). Conclusions: The intraocular pressure reduction efficacy is similar between latanoprost and selective laser trabeculoplasty. Glaucomatous patients who are medically controlled with latanoprost and switch treatment to selective laser trabeculoplasty maintain control of intraocular pressure.

摘要
目的：青光眼是全球范围内不可逆性失明的首要致病因素。峰值眼压（peak intraocular pressure）是青光眼进展的主要危险因素之一，而降低眼压仍是针对所有类型青光眼的唯一治疗策略。本研究的核心目的为：对比同一患者双眼分别采用0.005%拉坦前列素（latanoprost）单药治疗与对侧眼行选择性激光小梁成形术（selective laser trabeculoplasty, SLT）后，通过饮水试验（water drinking test）测得的基线眼压与峰值眼压降幅。
方法：本研究为一项前瞻性、干预性、纵向随机对照临床试验，招募自单家眼科中心的30例连续性纳入的青光眼患者，这些患者此前已通过拉坦前列素单药治疗实现眼压良好控制。对患者双眼进行随机分配，一眼接受选择性激光小梁成形术治疗，对侧眼则换用0.005%拉坦前列素滴眼液局部治疗。分别于治疗后1个月（第二次饮水试验）与6个月（第三次饮水试验）评估基线眼压与峰值眼压。
结果：随机分配至选择性激光小梁成形术组与拉坦前列素组的患眼，其洗脱前平均眼压无显著差异（分别为13.6±2.1 mmHg与13.3±1.8 mmHg；p=0.182）。就基线眼压而言，第二次饮水试验（p=0.689）与第三次饮水试验（p=0.06）中两组间均无显著差异。在第二次饮水试验（p=0.771）与第三次饮水试验（p=0.774）中，选择性激光小梁成形术组与拉坦前列素组的眼压峰值亦无显著差异。
结论：拉坦前列素与选择性激光小梁成形术的眼压降低疗效相当。已通过拉坦前列素单药实现眼压控制的青光眼患者，若转换为选择性激光小梁成形术治疗，仍可维持眼压的良好控制。