Comparison of the efficacy of latanoprost versus dorzolamide/timolol fixed combination therapy in patients with pseudoexfoliative glaucoma according to glaucoma stage

ABSTRACT Purpose: Only a few trials have compared the intraocular pressure-lowering effects of prostaglandin analogs to carbonic anhydrase inhibitor plus beta-blocker fixed-dose combination therapy in patients with pseudoexfoliative glaucoma. Furthermore, the influence of the glaucoma stage on the intraocular pressure-lowering effects of these drug types has not been studied. The purpose of this study was to compare the IOP-lowering efficacy of latanoprost, a prostaglandin analog versus dorzolamide/timolol fixed combination, a carbonic anhydrase inhibitor plus beta-blocker fixed-dose combination therapy, in patients with pseudoexfoliative glaucoma based on glaucoma stage. Methods: The data of 32 eyes (32 patients) diagnosed with uniocular pseudoexfoliative glaucoma and treated with topical latanoprost (Group 1) or dorzolamide/timolol fixed combination (Group 2) were retrospectively assessed. The groups were subdivided into early and moderate-advanced stages. Patients’ demographics, baseline intraocular pressure, final intraocular pressure, and intraocular pressure difference (the difference between the baseline and final intraocular pressure) were determined from medical records and compared between groups and according to glaucoma stage. Results: The mean drug use duration was 17.7 ± 13.5 months. No significant differences in mean baseline intraocular pressure, mean final intraocular pressure and mean intraocular pressure difference between Groups 1 and 2. In Group 2, the mean intraocular pressure difference was significantly greater in patients with early versus moderate-advanced stage glaucoma (p=0.015). The difference, however, was not detected in Group 1. The mean intraocular pressure difference in early-stage glaucoma was significantly greater in Group 2 versus 1 (p=0.033). Conclusions: Latanoprost and dorzolamide/timolol fixed combination are effective treatments for newly diagnosed pseudoexfoliative glaucoma. In early-stage pseudoexfoliative glaucoma, greater intraocular pressure reduction was noted with dorzolamide/timolol fixed combination than with latanoprost; thus, dorzolamide/timolol fixed combination should be considered when a significant decrease in intraocular pressure is desired in early-stage glaucoma.

摘要

## 目的
目前仅有少量研究对比了前列腺素类似物（prostaglandin analogs）与碳酸酐酶抑制剂（carbonic anhydrase inhibitor）联合β受体阻滞剂（beta-blocker）固定剂量复方制剂（fixed-dose combination）治疗剥脱性青光眼（pseudoexfoliative glaucoma）患者的降眼压效果。此外，青光眼分期对这类药物的降眼压效果的影响尚未被探讨。本研究旨在依据青光眼分期，对比前列腺素类似物拉坦前列素（latanoprost）与碳酸酐酶抑制剂联合β受体阻滞剂固定剂量复方制剂多佐胺/噻吗洛尔固定复方制剂（dorzolamide/timolol fixed combination）治疗剥脱性青光眼患者的降眼压疗效。

## 方法
本研究回顾性分析了32例单眼确诊剥脱性青光眼患者的32只患眼数据，所有患者均接受眼局部给药治疗，分别使用拉坦前列素（组1）或多佐胺/噻吗洛尔固定复方制剂（组2）。将两组患者进一步划分为早期青光眼与中晚期青光眼两个亚组。从患者的医疗记录中提取人口统计学资料、基线眼压（intraocular pressure, IOP）、最终眼压以及眼压差值（基线眼压与最终眼压的差值），并在组间以及按照青光眼分期进行比较分析。

## 结果
患者的平均用药时长为17.7±13.5个月。组1与组2在平均基线眼压、平均最终眼压以及平均眼压差值方面均无显著统计学差异。在组2中，早期青光眼患者的平均眼压差值显著高于中晚期青光眼患者（p=0.015），但该差异在组1中未被观测到。在早期青光眼患者中，组2的平均眼压差值显著高于组1（p=0.033）。

## 结论
拉坦前列素与多佐胺/噻吗洛尔固定复方制剂均为新确诊剥脱性青光眼的有效治疗方案。在早期剥脱性青光眼中，多佐胺/噻吗洛尔固定复方制剂的降眼压效果优于拉坦前列素；因此，若需显著降低早期青光眼患者的眼压，可考虑选用多佐胺/噻吗洛尔固定复方制剂。