乔教授青光眼的药物治疗策略ppt课件.ppt

* * 前列素类药物是目前市场上降压作用较大的产品，缩瞳剂和口服CAI尽管有很强的降眼压作用，但是副作用太多或者对大多数患者禁忌。前列素类药物降眼压作用最大（25-30%），它们既是作用最强的的单剂治疗 药物，也是相对患者依从性好的药物。 * Emerging paradigms in glaucoma therapy: Principles of Glaucoma Therapy. Glaucoma therapy is changing. 青光眼治疗在进步 Previous treatment paradigms focused on IOP as the major risk and targeted a maximum reduction in pressure. 以前的治疗强调眼压是主要危险因子,要求尽可能地降眼压.Consequently, many patients were treated identically, regardless of their individual needs.这导致患者接受相同的非个体化的治疗 Today, emerging research has shown the pathogenesis of glaucoma to be multi-factorial.今天的研究表明青光眼的病因是多因子的 In addition, studies such as AGIS, NTG, and OHT have identified a number of patient types and underscored the importance of appropriate individualized treatment.对于正常眼压性青光眼和高眼压症等的研究表明个体化治疗的必要性 Fluctuations of IOP have also been identified as an independent risk factor for the progression of glaucoma. 目前发现眼压波动也是青光眼病程进展的独立危险因子 Therefore the appropriate therapy should not only reduce IOP, but minimize IOP fluctuations and maintain consistent control.因而我们不仅要降眼压,而且要将眼压波动控制在最小范围. Finally, there are a diverse number of pharmacological treatment options available to the physician. 最后,因为现在有许多治疗方案可供选择. With the advent of many of these new medications have come a number of new adverse effects, previously not recognized with traditional glaucoma medications. 但新的疗法也带来了许多新的副作用. Consequently, it has become extremely important to match the treatment with the patient to avoid local and systemic adverse effects, which could lead to reduced compliance. 所以,针对不同的患者采用个体化的治疗方案以减少副作用,可以保证患者的依从性 青光眼药物和作用机制 三、选择性?2-受体激动剂 阿普可乐定 阿法根 作用机制：减少房水生成、增加房水从葡萄膜巩膜通 道流出。滴眼后2小时降眼压作用达峰值。 副作用：口干、头痛、疲倦。局部过敏、充血，痒。 禁忌症：使用单胺氧化酶抑制剂治疗的患者 慎用：体位性低血压，精神抑郁，血栓闭塞性脉管炎 青光眼药物和作用机制 四、局部用碳酸酐酶抑制剂 派立明( 布林佐胺 Azopt，爱尔康) 多佐胺(杜塞酰胺 Trusopt，默克) 作用机制：减少房水生成。 副作用：味觉改变(口苦或者异味)，一过性视物模糊 ，局部 刺激(滴药时灼烧感或者刺痛)，异物感和眼部充 血 ，无全身副作用。