不同類型青光眼之藥物治療策略

Medication Treatment Strategies of Different Types of Glaucoma

李芷葶(Jr-ting Lee) ； 謝昌達(Chang-da Hsieh)

《臺灣臨床藥學雜誌》 25卷2期 (2017/04) Pp. 109-122

https://doi.org/10.6168/FJCP.2017.2502.03

摘要

青光眼可大略分成原發性青光眼(primary glaucoma)、續發性青光眼(secondary glaucoma)及先天性青光眼(congenital glaucoma)三類。原發性青光眼又分為狹角性青光眼 (closed-angle glaucoma)和廣角性青光眼(open-angle glaucoma)。狹角性青光眼及先天性青光眼以手術治療為主；廣角性青光眼治療重點是避免視覺繼續喪失，且希望減少病人20 ~ 30% 眼內壓(intraocular pressure)，選用有效性及耐受性佳的藥物治療並定期監測病人治療效果，再加上病人良好用藥順從性及正確用藥方式，藥物可以進一步改善疾病進展可以成功控制60 ~ 80 %病人眼內壓超過5年期間；續發性青光眼治療，要治標也要治本，除了青光眼本身的治療外，也要找出造成續發性青光眼的原因，同時治療才能提升治療效果。儘管藥物和手術治療有效引導降低眼內壓，但青光眼變化的進展和視覺的消失在青光眼病人仍舊發生。根據青光眼研究基金會統計大約10%接受正規治療的青光眼病人，誘導降低眼壓後仍會產生視覺漸進消失。因此科學家專注在多樣性治療包括神經保護、免疫治療、補充神經營養因子、神經再生、刺激細胞訊息傳遞、氧化壓力等。本文將目前新的治療方式分成降低眼內壓治療、神經保護和神經再生三項策略詳細說明。

關鍵字

青光眼 ； 狹角性青光眼 ； 廣角性青光眼 ； 神經保護 ； 神經再生

並列摘要

Glaucoma can be roughly divided into three categories, primary glaucoma, secondary glaucoma, and congenital glaucoma. Primary glaucoma can be classified into closed-angle glaucoma and open-angle glaucoma. Closed-angle glaucoma and congenital glaucoma are mainly treated by surgery; whereas, the focus of the openangle glaucoma treatment is to avoid continued loss of vision, and is intended to reduce 20 to 30% of patients’ intraocular pressure. The initial treatment is drug-based, takes a stepwise approach, selects highly effective and tolerable drug therapy, and assesses the treatment outcome of patients on a regular basis. If the patient has good medication compliance and the correct mode of administration, the drugs can further improve the progression of the disease, and successfully control 60 ~ 80 % of patients’ intraocular pressure for more than 5 years. The treatment of secondary glaucoma should pay equal attention to symptoms and root causes. In addition to the treatment of glaucoma, the causes of secondary glaucoma must be identified, and the treatment outcome can be improved only by treating both the symptoms and causes. Although drug and surgical treatment is effective in reducing intraocular pressure, glaucoma patients still suffer from the progression of glaucoma and the loss of vision. According to the statistics issued by the Glaucoma Research Foundation, approximately 10% of the glaucoma patients receiving regular treatment will still gradually lose their vision after reducing intraocular pressure. Therefore, the scientists should concentrate on varied treatments such as neuroprotection, immunotherapy, supplement of neurotrophic factor, nerve regeneration, stimulation of cell signaling, and oxidative stress. This paper divides the current new methods of treatment into intraocular pressure therapy, neuroprotection and nerve regeneration.

並列關鍵字

Glaucoma ； Closed-Angle Glaucoma ； Open-Angle Glaucoma ； Neuroprotection ； Neuroregeneration