[眼部对抗青光眼药物的不耐受被低估了]。

H Bresson-Dumont
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引用次数: 0

摘要

大约20年来,抗青光眼滴眼液的大量使用已经彻底改变了青光眼的治疗方法。滤过手术指征的频率有所下降。很多病人只能靠药物控制病情。然而,直到50%的病例报告有眼部不耐受和副作用,10%的病例有严重的不耐受表现。局部用药的眼部副作用常常会改变用药的依从性。眼不耐受已被证明是继发于免疫机制和直接或间接毒性。免疫或过敏机制由I型或IV型超敏反应引起,仅占局部药物引起的所有副作用的3%至10%。毒性作用可以通过不同的机制直接产生:纯毒性作用、酸性pH、溶液渗透压、光敏性。这将诱发炎症反应,并在长期内产生纤维化。这种毒性作用会因眼睛干燥或酒糟鼻而恶化。毒性也可以通过结膜微生物菌群和/或泪液分泌的改变而间接发生。伴随的泪道阻塞也可能导致这种效果。这些机制可以通过结膜标记的组织学研究和最近的共聚焦HRT来阐明,共聚焦HRT给出了体内眼表的分析。适当和早期发现抗青光眼药物不耐受是必要的,以调整相应的管理策略。这些是基于尽可能抑制或减少保守药物,使用固定组合,减少滴注次数和对眼表的相关治疗。
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[Ocular intolerance to antiglaucoma medications is underestimated].

Since about 20 years, the large panel of the antiglaucoma eyedrops has drastically changed the management of glaucoma. Indications for filtering surgery had decreased in frequency. A great number of patients are controlled only by medications. However ocular intolerance and side effects have been reported until in 50% of the cases with 10% of severe manifestations of intolerance. Ocular side effects to topical medications may very often alter compliance. Ocular intolerance had been shown to be secondary to immunological mechanisms and direct or indirect toxicity. The immunological or allergic mechanisms are induced by a type I or IV hypersensibility and only represent 3% to 10% of all the side effects induced by topical medications. Toxic effect can be a direct through different mechanisms: pure toxic effect, acid pH, osmolarity of the solution, photosensibilisation. This will induce inflammatory reaction that will produce fibrosis in the long term. This toxic effect can be worsened by eye dryness or rosacea. Toxicity can also be indirect through an alteration of the conjunctival microbial flora and/or the lacrymal secretion. Concomitant obstruction of the lacrymal ducts may also contribute to this effect. These mechanisms could have been elucidated thank to histological studies from conjunctival mark, and more recently with confocal HRT, which gives an analysis of the ocular surface in vivo. Appropriate and early detection of intolerance to antiglaucoma medications is mandatory to adjust management strategies accordingly. These are based on the suppression or the reduction of conservative agents whenever possible, the use of fixed combinations, the reduction of the number of the instillations and the associated treatment of the ocular surface.

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