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导致不可逆失明的首要病因。眼压（intraocular pressure）峰值是青光眼进展的主要危险因素之一，而降低眼压仍是所有类型青光眼的唯一治疗策略。本研究旨在对比同一患者双眼分别接受0.005%拉坦前列素（latanoprost）单眼给药与对侧眼选择性激光小梁成形术（selective laser trabeculoplasty, SLT）治疗后，通过饮水试验（water drinking test）测得的基线眼压与眼压降幅峰值。
方法：本研究为一项前瞻性、干预性、纵向随机临床试验，从单一眼科中心招募30例经拉坦前列素单药治疗且眼压控制良好的连续性青光眼患者。将患者双眼随机分组，一眼接受选择性激光小梁成形术治疗，对侧眼则启用0.005%拉坦前列素局部给药。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）评估基线眼压与眼压峰值。
结果：随机分组至选择性激光小梁成形术组与拉坦前列素组的患者，其洗脱前平均眼压分别为13.6±2.1 mmHg与13.3±1.8 mmHg，组间差异无统计学意义（p=0.182）。在基线眼压方面，第二次饮水试验（p=0.689）与第三次饮水试验（p=0.06）的组间差异均无统计学意义。第二次饮水试验（p=0.771）与第三次饮水试验（p=0.774）中，两组的眼压峰值差异亦无统计学意义。
结论：0.005%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。经拉坦前列素药物治疗眼压控制良好的青光眼患者，转换为选择性激光小梁成形术治疗后，仍可维持眼压控制。