抗青光眼局部药物的合理应用吉林大学第二医院.ppt

视神经损害的药物治疗 1.钙离子通道拮抗剂 2.NMDA受体拮抗剂: MK801,Memantine 3.NO合成酶抑制剂: 2-Aminoguaniding, 精氨酸 4.免疫治疗: Cop-1 Vaccine 5.神经营养剂 6.抗氧化剂和自由基清除剂 7.中药 神经营养剂 各种神经生长因子： BDNF, CNGF, bFGF, IGF，PDGF,神经节苷酯 周围神经营养剂：B族维生素 甲钴胺(弥可保) 视神经保护作用的中药 银杏 丹参 益脉康 血栓通 中药视神经保护作用可能机制 改善视网膜和视神经微循环 抗氧化 抑制细胞凋亡 抑制兴奋性毒素 其它…… 理想的青光眼药物 有效性 安全性 耐受性 依从性 持久性 总结 掌握药物治疗适应症 合理选择降眼压药物 考虑个体特征及依从性 客观评价疗效、及时手术 谢谢 * NOTE TO THE PRESENTER- Slides 15 and 16 can be used with any data slides to provide an abbreviated summary of these trials and their results. Slide 16 summarizes the overall results of the trials and restates the information on slide 35. In each of these trials, patients who reached lower pressures had better visual outcomes. Treatment prevented the development of glaucoma in individuals with OHT, and it reduced and delayed the progression of early glaucoma. The results of EMGT show that aggressive treatment is beneficial in early glaucoma. Glaucoma progression was reduced and delayed in patients with newly detected glaucoma who were treated to reduce IOP. Treatment was beneficial for both POAG and NTG patients. This study was planned in the early 1990s and used treatment available at the time that was believed to be safe. (This statement is in response to the criticism that the trial used an unusual combination of medication with ALT for the treatment group.) Every 1 mm Hg of additional IOP lowering led to a 10% decrease in the risk of glaucoma progression. The average sustained IOP reduction in treated patients was 25%. Together the results of this study suggest that aggressive treatment providing 30% or 35% mean IOP reductions will protect the visual function of more patients. [1] CIGTS Results Both medical treatment and surgery effectively reduced IOP by 38% to 46% and the risk of progression to 10.7% to 13.5% over 5 years Target pressures used were aggressive A target IOP reduction of ? 25% from baselin