摘要:
背景 青光眼视神经病变的发生与进展有部分与眼球后血流动力学障碍有关,复方樟柳碱注射液在临床上用于治疗眼缺血性疾病. 目的 评估复方樟柳碱注射液对青光眼患者眼血流的影响. 方法 将21例原发性青光眼患者分为治疗组和对照组,治疗组视野平均偏差(MD)较大者作为治疗眼,并亚分为治疗眼组和对侧眼组,对照组取MD值较大者纳入研究.治疗组11例患者在原有抗青光眼治疗基础上,治疗眼加用复方樟柳碱注射液颞浅动脉旁皮下注射,每日1次,治疗2个疗程(每个疗程14 d,间隔7d,治疗周期共35 d),对侧眼不予处理.对照组10例,原有治疗方案不变,不予注射.治疗组及对照组均在治疗周期前(基线)、治疗周期后1d(第1次复查)、治疗周期后35 d(第2次复查)分别行双眼球后血流、视盘结构、验光、视野及眼压检查.结果 治疗后第1次复查,治疗眼组睫状后短动脉(SPCA)的收缩期峰值流速(PSV)及舒张末期流速(EDV)均较对照组增加,差异均有统计学意义(P=0.017、0.028).治疗后第1次复查,对侧眼组SPCA的PSV较对照组增加,差异有统计学意义(P=0.049);治疗后第2次复查时,对侧眼组视网膜中央动脉(CRA)的EDV较对照组增加,差异有统计学意义(P=0.035).视盘下方视网膜神经纤维层(RNFL)厚度值测量结果显示,对照组第2次复查时测量值明显低于治疗眼组,差异有统计学意义(P=0.009).视盘6:00位的RNFL厚度检测发现,第1次及第2次复查时对照组RNFL厚度值明显低于治疗眼组,差异均有统计学意义(P=0.014、0.029);视盘7:00位的RNFL厚度检测发现,第2次复查时治疗眼组与对照组比较,差异有统计学意义(P=0.011). 结论 复方樟柳碱注射液治疗可使原发性青光眼患者SPCA的PSV和EDV相对增加.%Background The incidence and progression of glaucomatous optic neuropathy is related to a disturbance of the retrobulbar hemodynamics.Compound anisodine is clinically applied for the treatment of ischemic ocular diseases.Objective To evaluate the effects of compound anisodine injection on the ocular blood flow of glaucoma patients.Methods Twenty-one patients with primary glaucoma were divided into the treatment group and the control group.The eyes of each patient in the treatment group were selected further into the treatment eye group (11 eyes with greater mean deviation [MD]) or the opposite eye group(11 eyes with lesser MD).One of the eyes of each patient in the control group with MD value were selected as control eyes (10 eyes).The treatment eye group received compound anisodine on the para-superficial temporal artery via subcutaneous injection once a day for 2 treatment periods (each period equals 14 days,with 7 days intermittent between periods,totally 35 days) in addition to routine treatment.The retrobulbar blood flow,optic disc data,refraction error,visual field and intraocular pressure were measured in 3 time points:Before treatment period (baseline test),one day after treatment period (the 1st postreatment test) and 35 days after treatment period (the 2nd posttreatment test).Results Compared with the control group,the peak systolic velocity (PSV) and end diastolic velocity (EDV) of short posterior ciliary artery (SPCA) of the treatment eye group were relatively increased significantly in the 1st posttreatment test (P =0.017,0.028),the PSV of SPCA of the opposite eye group was relatively increased significantly in the 1 st posttreatment test (P =0.049),the EDV of central retinal artery (CRA) of the opposite eye group was relatively increased significantly in the 2nd posttreatment test (P =0.035).In contrast to the treatment eye group,the inferior quadrant RNFL thickness of the optic disc decreased significantly in the 2nd posttreatment test in the control group (P =0.009),the 6 o'clock RNFL thicknesses of the optic disc decreased significantly in the 1 st posttreatment test in the control group (P =0.014),and the 6 o'clock and 7 o'clock RNFL thicknesses of the optic disc decreased significantly in the 2nd posttreatment test in the control group (P =0.029,0.011).Conclusions The application of compound anisodine for the treatment of primary glaucoma relatively increases the PSV and EDV of SPCA.