今日の臨床サポート

続発緑内障

著者: 岩尾圭一郎1) 健軍桜木眼科

著者: 稲谷 大2) 福井大学医学部眼科学教室

監修: 沖波聡 倉敷中央病院眼科

著者校正/監修レビュー済:2022/04/27
参考ガイドライン:
  1. 日本緑内障学会:緑内障診療ガイドライン第5版
患者向け説明資料

概要・推奨   

  1. 続発緑内障の治療は可能な限り原疾患の治療を第一とする。眼圧上昇機序を把握して治療法を選択する(推奨度1 J)。
  1. 続発緑内障に対して、点眼による眼圧下降治療を行う場合、基本的には原発開放隅角緑内障への対処に準じて治療を行う(推奨度1 J)。
  1. リパスジル点眼薬は眼圧下降点眼薬を多剤使用している続発緑内障においても、有効な追加眼圧下降効果を有する(推奨度2 O)。
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薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
岩尾圭一郎 : 未申告[2021年]
稲谷 大 : 講演料(ノバルティス,興和,参天製薬,千寿製薬,グラウコス),奨学(奨励)寄付など(千寿製薬,エイエムオー・ジャパン,参天製薬)[2021年]
監修:沖波聡 : 特に申告事項無し[2021年]

改訂のポイント:
  1. 新しい眼圧下降点眼薬の登場に伴い記述を追加し、チューブシャント手術について追記を行った。
  1. 緑内障診療ガイドライン第5版に基づき改訂した。

病態・疫学・診察

疾患情報  
  1. 続発緑内障は、他の眼疾患、全身疾患あるいは薬物使用が原因となって眼圧上昇が生じる緑内障である[1]
  1. 現在の緑内障ガイドラインでは、緑内障診断は緑内障性視神経症(GON)を有する症例で定義されているが、本症の一部では、GONによる視神経の形態変化や視野変化の評価が困難なものが含まれ、従来どおり続発性の眼圧上昇を有する症例を含めるものとなっている。しかしながら、一部の文献では、GONを伴わない場合には高眼圧症として扱っているものもある[1]
  1. 眼圧上昇の機序により、続発開放隅角緑内障(線維柱帯~前房・線維柱帯・Schlemm管より後方に房水流出抵抗の主座が存在するもの)、続発閉塞隅角緑内障(瞳孔ブロック、虹彩-水晶体の前方移動による直接隅角閉塞、水晶体より後方に存在する組織の前方移動、周辺虹彩前癒着によるもの)に大別される。
 
続発緑内障の分類

眼圧上昇の機序により、続発開放隅角緑内障(線維柱帯~前房・線維柱帯・Schlemm管より後方に房水流出抵抗の主座が存在するもの)、続発閉塞隅角緑内障(瞳孔ブロック、虹彩-水晶体の前方移動による直接隅角閉塞、水晶体より後方に存在する組織の前方移動、周辺虹彩前癒着によるもの)に大別される。

 
  1. 原因疾患を把握し、眼圧上昇機転を理解して原因疾患の治療を行うことが眼圧下降の基本である。しかしながら、大部分の症例は、点眼をはじめとする眼圧下降薬を併用しながら原因疾患の治療に当たる場合が多い。
問診・診察のポイント  
  1. 過去の全身疾患や眼科疾患の既往、服用歴を確認する。

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文献 

著者: W J Scherer, F A Hauber
雑誌名: J Glaucoma. 2000 Apr;9(2):179-82.
Abstract/Text PURPOSE: To study the effect of monotherapy with latanoprost 0.005% on intraocular pressure (IOP) in a prospective nonrandomized clinical trial of patients newly diagnosed with steroid-induced secondary open-angle glaucoma.
PATIENTS AND METHODS: Eight patients (16 eyes) with newly diagnosed steroid-associated secondary open-angle glaucoma were prescribed latanoprost 0.005% once a day in each eye. The initial IOP before treatment served as an internal control for each eye. Intraocular pressure was remeasured after 1 month of monotherapy with latanoprost. Investigators (WJS) were blinded to initial IOP at the time of remeasurement. After discontinuation of steroids, IOP was rechecked. If IOP was stable, latanoprost was discontinued. Intraocular pressure was rechecked 2 to 4 weeks later to confirm an association with steroid use.
RESULTS: Intraocular pressure was significantly decreased after treatment with latanoprost (18.3 +/- 2.8 mm Hg) compared with initial IOP (25.3 +/- 9.1 mm Hg). This change represented a 28% decrease in IOP compared with baseline levels. Average IOP after discontinuation of steroids and latanoprost (17.3 +/- 1.4 mm Hg) did not differ from IOP measured during treatment with latanoprost, but it was significantly less than the initial IOP before treatment. No adverse effects were noted.
CONCLUSIONS: Monotherapy with latanoprost is safe and effective in patients with steroid-induced glaucoma. Advantages include lack of systemic side effects and convenient once-daily dosing.

PMID 10782629  J Glaucoma. 2000 Apr;9(2):179-82.
著者: M Honjo, H Tanihara, M Inatani, Y Honda
雑誌名: J Glaucoma. 2000 Dec;9(6):483-5.
Abstract/Text PURPOSE: To investigate the effect of external trabeculotomy on eyes with steroid-induced glaucoma.
METHODS: We retrospectively analyzed the surgical results of 14 eyes of seven patients that underwent trabeculotomy for the first surgical procedure. All patients had the history of receiving topical or systemic corticosteroids before the rise of intraocular pressure had been noted.
RESULTS: After an average follow-up of 60.6 +/- 33.5 months, in all of the 14 eyes, intraocular pressure was well controlled below or equal to 21 mm Hg at the final examinations.
CONCLUSIONS: Surgical results of external trabeculotomy remain effective for a long time. It has been shown that the trabeculotomy can be a useful and effective surgical treatment of patients with steroid-induced glaucoma.

PMID 11131756  J Glaucoma. 2000 Dec;9(6):483-5.
著者: Keiichiro Iwao, Masaru Inatani, Hidenobu Tanihara, Japanese Steroid-Induced Glaucoma Multicenter Study Group
雑誌名: Am J Ophthalmol. 2011 Jun;151(6):1047-1056.e1. doi: 10.1016/j.ajo.2010.11.028. Epub 2011 Mar 10.
Abstract/Text PURPOSE: To evaluate the surgical outcomes of trabeculotomy for steroid-induced glaucoma.
DESIGN: Multicenter, retrospective cohort study.
METHODS: At 17 Japanese clinical centers, 121 steroid-induced glaucoma patients who underwent trabeculotomy between 1997 and 2006 were reviewed. Surgical failure was defined by the need for additional glaucoma surgery, deterioration of visual acuity to no light perception, or intraocular pressure ≥21 mm Hg (criterion A) and ≥18 mm Hg (criterion B). Surgical outcomes were compared with those of 108 primary open-angle glaucoma (POAG) patients who underwent trabeculotomy and 42 steroid-induced glaucoma patients who underwent trabeculectomy. Prognostic factors for failure were evaluated using the Cox proportional hazards model.
RESULTS: The probabilities of success at 3 years for trabeculotomy for steroid-induced glaucoma vs trabeculotomy for POAG was 78.1% vs 55.8% for criterion A (P = .0008) and 56.4% vs 30.6% for criterion B (P < .0001), respectively. At 3 years, the success of trabeculotomy for steroid-induced glaucoma was comparable to trabeculectomy for steroid-induced glaucoma for criterion A (83.8%; P = .3636), but lower for criterion B (71.6%; P = .0352). Prognostic factors for failure of trabeculotomy for steroid-induced glaucoma were previous vitrectomy (relative risk [RR] = 5.340; P = .0452 on criterion A, RR = 3.898; P = .0360 for criterion B) and corticosteroid administration other than ocular instillation (RR = 2.752; P = .0352 for criterion B).
CONCLUSIONS: Trabeculotomy is effective for controlling intraocular pressure <21 mm Hg in steroid-induced glaucoma eyes.

Copyright © 2011 Elsevier Inc. All rights reserved.
PMID 21396622  Am J Ophthalmol. 2011 Jun;151(6):1047-1056.e1. doi: 10.・・・
著者: Shahin Yazdani, Kamran Hendi, Mohammad Pakravan, Manijeh Mahdavi, Mehdi Yaseri
雑誌名: J Glaucoma. 2009 Oct-Nov;18(8):632-7. doi: 10.1097/IJG.0b013e3181997211.
Abstract/Text PURPOSE: To determine the effect of intravitreal bevacizumab (IVB) on neovascular glaucoma (NVG) in terms of iris neovascularization (NVI), intraocular pressure (IOP), and visual acuity.
METHODS: This randomized controlled trial included 26 eyes of 26 patients with NVG. All eyes received conventional treatment for NVG and were randomly allocated to three 2.5 mg IVB injections at 4-week intervals or a sham procedure (subconjunctival normal saline) at similar time intervals and in the same setting.
RESULTS: Overall, 14 eyes of 14 patients received IVB and 12 eyes of 12 subjects were allocated to the sham procedure and followed for a mean period of 5.9+/-1.4 months. The IVB group demonstrated significant reduction in IOP from a baseline value of 33.4+/-14.5 mm Hg to 21.8+/-13.7 mm Hg (P=0.007), 25.1+/-20 mm Hg (P=0.058), and 23.9+/-18.7 mm Hg (P=0.047) at 1, 3, and 6 months after intervention, respectively. NVI was also significantly reduced from a mean baseline value of 347+/-48 degrees to 206+/-185 degrees (P=0.01), 180+/-187 degrees (P=0.004), and 180+/-180 degrees (P=0.004) at 1, 3, and 6 months after intervention. In contrast, IOP and NVI remained unchanged or increased insignificantly at all follow-up intervals in the control group. No significant change in visual acuity was observed within the study groups at any time interval. The study groups were comparable in terms of requirement for additional interventions such as panretinal photocoagulation and cyclodestructive procedures.
CONCLUSIONS: Intravitreal injections of bevacizumab seem to reduce NVI and IOP in NVG and may be considered as an adjunct to more definitive surgical procedures for NVG.

PMID 19826393  J Glaucoma. 2009 Oct-Nov;18(8):632-7. doi: 10.1097/IJG.・・・
著者: Aachal Kotecha, Alexander Spratt, Lola Ogunbowale, Roberto dell'Omo, Avinash Kulkarni, Catey Bunce, Wendy A Franks
雑誌名: Arch Ophthalmol. 2011 Feb;129(2):145-50. doi: 10.1001/archophthalmol.2010.350.
Abstract/Text OBJECTIVE: To examine the efficacy of intravitreal bevacizumab for pain relief in eyes with refractory neovascular glaucoma.
METHODS: In this prospective case series, 52 eyes with neovascular glaucoma were administered intravitreal bevacizumab, 1.25 mg, and monitored for 6 months. The primary outcome measure was change in subjective pain score. Intraocular pressure and iris neovascularization were evaluated at each visit. Surgical intervention for control of intraocular pressure was performed according to clinical need.
RESULTS: Forty-two patients (44 eyes) completed the 6-month follow-up. Subjective pain score was reduced significantly 1 week after intravitreal bevacizumab injection and lasted throughout the follow-up period (median [interquartile range]: baseline, 3 [0-6]; week 1, 1 [0-3]; month 1, 0 [0-1]; month 3, 0 [0-1]; and month 6, 0 [0-0]; Kruskal-Wallis χ(2) 31.03; P < .001). A rapid, yet relatively transient, reduction in iris neovascularization was also noted (iris neovascularization grade at baseline, 4.0 [3-4]; week 1, 2.5 [1-4]; month 1, 2.0 [1-4]; month 3, 3.0 [2-4]; and month 6, 3.0 [2-4], χ(2) 23.33; P < .001). Four eyes (8%) required more than 1 injection to facilitate further intraocular surgery.
CONCLUSIONS: Intravitreal bevacizumab is a useful adjunct in the management of refractory neovascular glaucoma, producing rapid relief of pain. However, we found no evidence to suggest that intravitreal bevacizumab lowers intraocular pressure in eyes with angle closure; conventional medical, laser, and surgical treatment are still needed in these eyes.

PMID 21320957  Arch Ophthalmol. 2011 Feb;129(2):145-50. doi: 10.1001/a・・・
著者: Taku Wakabayashi, Yusuke Oshima, Hirokazu Sakaguchi, Yasushi Ikuno, Atsuya Miki, Fumi Gomi, Yasumasa Otori, Motohiro Kamei, Shunji Kusaka, Yasuo Tano
雑誌名: Ophthalmology. 2008 Sep;115(9):1571-80, 1580.e1-3. doi: 10.1016/j.ophtha.2008.02.026. Epub 2008 Apr 28.
Abstract/Text PURPOSE: To evaluate the biologic efficacy of intravitreal bevacizumab (IVB) for iris neovascularization (INV) or neovascular glaucoma (NVG) in patients with ischemic retinal disorders.
DESIGN: Retrospective, consecutive, interventional case series.
PARTICIPANTS: Thirty patients (41 eyes) with INV or NVG secondary to ischemic retinal disorders.
METHODS: Patients received IVB (1 mg) as the initial treatment for INV or NVG and were followed up for at least 6 months. Ophthalmic evaluations included measurement of visual acuity and intraocular pressure (IOP), a complete ophthalmic examination, and fluorescein angiography. Patients were divided into 3 subgroups: INV without elevated IOP (INV group), NVG with an open angle (O-NVG group), and NVG with angle closure (C-NVG group) for outcomes analysis.
MAIN OUTCOME MEASURES: The controllability of IOP by IVB, incidence of recurrence, and requirement for surgery to treat NVG.
RESULTS: No significant ocular or systemic adverse events developed during follow-up (range, 6-22 months; mean, 13.3 months). The mean IOP levels were 14.7, 31.2, and 44.9 mmHg at baseline in the INV, O-NVG, and C-NVG groups, respectively. In the INV group (9 eyes), the INV regressed or resolved after 1 injection. Iris neovascularization recurred in 4 eyes by 6 months and stabilized after repeated injections without IOP elevation. In the O-NVG group (17 eyes), rapid neovascular regression with successful IOP normalization (CONCLUSIONS: Intravitreal bevacizumab is well tolerated, effectively stabilized INV activity, and controlled IOP in patients with INV alone and early-stage NVG without angle closure. In advanced NVG, IVB cannot control IOP but may be used adjunctively to improve subsequent surgical results. Further evaluation in controlled randomized studies is warranted.

PMID 18440643  Ophthalmology. 2008 Sep;115(9):1571-80, 1580.e1-3. doi:・・・
著者: Viney Gupta, Randhir Jha, Aparna Rao, George Kong, Ramanjit Sihota
雑誌名: Eur J Ophthalmol. 2009 May-Jun;19(3):435-41.
Abstract/Text PURPOSE: To prospectively evaluate the effect of 1.25 mg and 2.5 mg intracameral bevacizumab on surgical outcomes of trabeculectomy for neovascular glaucoma (NVG), with primary outcome measures being the regression of neovascularization of iris (NVI) and reduction of intraocular pressure (IOP).
METHODS: Consecutive patients with neovascular glaucoma from December 2006 to March 2007 were randomized into two cohorts assigned to receive 1.25 mg (Group 1) or 2.5 mg (Group 2) intracameral bevacizumab prior to undergoing mitomycin C (MMC) trabeculectomy. Surgical outcome measures were evaluated following initial injection and during follow-up post-surgery.
RESULTS: The most common causes for iris neovascularization were central retinal vein occlusion (47.3%) and proliferative diabetic retinopathy (36.8%). Following intracameral bevacizumab, there was a reduction in IOP compared to baseline in both treatment groups (Group 1, n=9: -10.4+/-4.5 mmHg, p=0.57; Group 2, n=10: -12.1+/-5.5 mmHg, p=0.1). The reduction in IOP was not statistically significant between the two groups (p=0.55). None of the eyes underwent further retinal ablation post trabeculectomy. Reappearance of NVI was seen in three eyes (Group 1, n=2; Group 2, n=1) after 3 months. There was no statistically significant difference in regression of NVI grade between the treatment groups (p=0.1).
CONCLUSIONS: The efficacy of an intracameral dose of 2.5 mg of bevacizumab prior to trabeculectomy for eyes with NVG is not significantly different from a 1.25 mg dose. Intracameral bevacizumab followed by trabeculectomy results in good surgical outcomes. Longer follow-up would be needed to evaluate differences in recurrence rates of iris neovascularization using different dosages.

PMID 19396791  Eur J Ophthalmol. 2009 May-Jun;19(3):435-41.
著者: Yoshiaki Saito, Tomomi Higashide, Hisashi Takeda, Shinji Ohkubo, Kazuhisa Sugiyama
雑誌名: Acta Ophthalmol. 2010 Feb;88(1):96-102. doi: 10.1111/j.1755-3768.2009.01648.x. Epub 2009 Sep 23.
Abstract/Text PURPOSE: This study aimed to investigate the effects of preoperative intravitreal bevacizumab (IVB) on outcomes in trabeculectomy for neovascular glaucoma (NVG).
METHODS: Charts for 52 NVG eyes of 52 consecutive patients who received primary trabeculectomy with mitomycin C (MMC) were reviewed. Postoperative follow-up periods for all patients were > or = 4 months. Thirty-two consecutive eyes were treated without IVB (control group) and 20 consecutive eyes received IVB (1.25 mg) 10 +/- 11 days before trabeculectomy (IVB group). The main outcome measures were postoperative intraocular pressure (IOP) and incidence of postoperative complications. Surgical success was defined as IOP< 21 mmHg with or without medication (qualified or complete success, respectively). Failure was defined as IOP exceeding these criteria, phthisis bulbi, loss of light perception or additional glaucoma surgeries. Kaplan-Meier survival analysis with the log-rank test was performed to compare surgical success rates between the two groups.
RESULTS: Complete and qualified success rates at 6 months were 95% versus 50% and 95% versus 75% in the IVB and control groups, respectively. The IVB group achieved significantly better surgical success rates than the control group (complete success, p < 0.001; qualified success, p = 0.026). Postoperative hyphaema on day 1 or hyphaema with a duration of > 1 week occurred significantly less frequently in the IVB group than in the control group (p = 0.009, p = 0.014, respectively). The incidence of serious complications such as endophthalmitis, phthisis bulbi and a marked decrease in visual acuity did not increase in the IVB group.
CONCLUSIONS: This retrospective study showed that preoperative IVB decreased postoperative hyphaema and increased surgical success rates, and thus may be an effective adjunct to trabeculectomy in NVG.

PMID 19775309  Acta Ophthalmol. 2010 Feb;88(1):96-102. doi: 10.1111/j.・・・
著者: Yuji Takihara, Masaru Inatani, Takahiro Kawaji, Mikiko Fukushima, Keiichiro Iwao, Minako Iwao, Hidenobu Tanihara
雑誌名: J Glaucoma. 2011 Mar;20(3):196-201. doi: 10.1097/IJG.0b013e3181d9ce12.
Abstract/Text PURPOSE: To evaluate the effects of intravitreal bevacizumab (IVB) before mitomycin C trabeculectomy (MMCT) for neovascular glaucoma (NVG).
METHODS: The study is a retrospective, comparative, consecutive case series. The study group consisted of 57 eyes from 50 patients with NVG who underwent a first MMCT: 33 eyes were treated with MMCT alone between June 1, 2005 and May 17, 2007 (Control Group); and, 24 eyes were treated with a combination of IVB and MMCT after May 18, 2007 (IVB Group). Surgical complications, intraocular pressure (IOP), and the probability of success were compared between the 2 groups. Surgical failure was defined as IOP ≥22 mm Hg for 2 consecutive follow-up visits, a deterioration of visual acuity to no light perception, or additional glaucoma surgeries.
RESULTS: There were no significant differences in preoperative data between the groups. Hyphema associated with MMCT occurred significantly less often in the IVB Group (P=0.006). IOPs at 7 and 10 days after MMCT were significantly lower in the IVB Group (P=0.01 and 0.02, respectively). However, Kaplan-Meier survival-curve analysis showed the probability of success 120, 240, and 360 days after MMCT of 87.5%, 79.2%, and 65.2% in the IVB Group, and 75.0%, 71.9%, and 65.3% in the Control Group. No significant difference in survival times was found between the groups (P=0.76).
CONCLUSIONS: IVB before MMCT reduced hyphema associated with MMCT for NVG. IVB provided further IOP reduction immediately after MMCT, but did not significantly improve surgical outcomes over longer periods.

PMID 20440215  J Glaucoma. 2011 Mar;20(3):196-201. doi: 10.1097/IJG.0b・・・
著者: S Ohno, A Ichiishi, H Matsuda
雑誌名: Ophthalmologica. 1989;199(1):41-5.
Abstract/Text The therapeutic effects of carteolol hydrochloride were evaluated in the treatment of 44 uveitis patients (51 eyes) with intraocular pressure elevation or secondary glaucoma. Carteolol ophthalmic solutions, either 1% or 2%, were given twice day for more than 4 weeks in glaucomatocyclitic crisis and for more than 8 weeks in other forms of uveitis. Intraocular pressure significantly decreased from week 1 of treatment and persisted within normal limits until week 8 in glaucomatocyclitic crisis. Similarly, intraocular pressure decreased significantly from week 2 in other forms of uveitis. Intraocular pressure was well controlled in patients with open-angle glaucoma, but the control was insufficient in patients with angle-closure glaucoma. No adverse reactions such as systemic hemodynamic effects or exacerbations of intraocular inflammation were observed during this study. Carteolol therefore seems to be effective for the treatment of intraocular pressure elevation and secondary glaucoma associated with endogenous uveitis.

PMID 2761985  Ophthalmologica. 1989;199(1):41-5.
著者: Rachel W Kuchtey, Careen Y Lowder, Scott D Smith
雑誌名: Ophthalmol Clin North Am. 2005 Sep;18(3):421-30, vii. doi: 10.1016/j.ohc.2005.05.004.
Abstract/Text Uveitic glaucoma can pose some of the most challenging management problems faced by the ophthalmologist. A better understanding of the pathogenesis of glaucoma associated with ocular inflammatory disease is an important key to making appropriate therapeutic decisions. This article provides an update on recent advances in understanding the epidemiology and pathogenesis of uveitic glaucoma, as well as developments in the diagnosis and management of this condition.

PMID 16054999  Ophthalmol Clin North Am. 2005 Sep;18(3):421-30, vii. d・・・
著者: R E Warwar, J D Bullock, D Ballal
雑誌名: Ophthalmology. 1998 Feb;105(2):263-8.
Abstract/Text OBJECTIVE: This study aimed to investigate the incidence of cystoid macular edema and anterior uveitis associated with the use of latanoprost.
DESIGN: A retrospective review of patients treated with latanoprost in the authors' practice between September 1, 1996, and August 1, 1997, was performed.
PARTICIPANTS: Ninety-four patients and 163 eyes were studied.
INTERVENTION: Patients presenting with signs and symptoms of ocular inflammation while receiving latanoprost were noted, and their response to the discontinuation of the drug was recorded.
MAIN OUTCOME MEASURES: The presence and degree of anterior uveitis and cystoid macular edema were measured.
RESULTS: Six (6.4%) of 94 patients (8 [4.9%] of 163 eyes) had anterior uveitis develop, and 2 (2.1%) of 94 patients (2 [1.2%] of 163 eyes) had cystoid macular edema develop while being treated with latanoprost.
CONCLUSION: Although latanoprost is an effective ocular-hypotensive agent, the authors' experience with the drug has shown a significant incidence of anterior uveitis and cystoid macular edema. To the authors' knowledge, this is the first study to report the incidence of both cystoid macular edema and anterior uveitis associated with latanoprost therapy. Treating physicians should be aware of these potential complicating side effects of latanoprost.

PMID 9479285  Ophthalmology. 1998 Feb;105(2):263-8.
著者: S L Smith, C A Pruitt, C S Sine, A C Hudgins, W C Stewart
雑誌名: Acta Ophthalmol Scand. 1999 Dec;77(6):668-72.
Abstract/Text PURPOSE: To evaluate the association of latanoprost with anterior chamber uveitis in glaucoma patients.
METHODS: We retrospectively reviewed 527 charts in latanoprost treated patients with: no prior uveitis (Group 1); prior uveitis but were inactive at the time of the study (Group 2); and active uveitis (Group 3).
RESULTS: In Group 1 five (1.0%) of 505 patients developed uveitis after beginning latanoprost. The uveitis was trace to 1+ cell in severity and delayed in onset 99.8+/-73.9 days In Group 2 three of 13 (23.1%) patients developed delayed uveitis (trace to 1+ cell). In Group 3 zero of nine (0%) patients had worsened inflammation and the intraocular pressure remained unchanged (22.8+/-7.8 mmHg to 22.0+/-7.3 mmHg) after beginning latanoprost (p=0.38).
CONCLUSION: In patients without a prior history a mild delayed uveitis with latanoprost treatment may develop rarely. In patients with a uveitis history, a mild delayed exacerbation potentially may occur and the intraocular pressure may not be decreased in active uveitis.

PMID 10634560  Acta Ophthalmol Scand. 1999 Dec;77(6):668-72.
著者: J H Chang, P McCluskey, T Missotten, P Ferrante, B Jalaludin, S Lightman
雑誌名: Br J Ophthalmol. 2008 Jul;92(7):916-21. doi: 10.1136/bjo.2007.131037. Epub 2008 May 6.
Abstract/Text AIM: A retrospective comparative case series was studied to determine whether the use of prostaglandin (PG) analogues to treat raised intraocular pressure (IOP) in patients with uveitis resulted in an increase in the frequency of anterior uveitis or cystoid macular oedema (CMO).
METHODS: 163 eyes of 84 consecutive patients with uveitis and raised IOP treated with a PG analogue at two tertiary referral uveitis clinics were identified over a 3-month period. Control eyes were selected as those uveitic eyes of the same patients, which were treated with topical IOP-lowering agent(s) other than a PG analogue. Pretreatment IOP was compared with the mean IOP during PG analogue treatment. The frequency of anterior uveitis and CMO during PG analogue treatment was compared with the frequency of these complications in the control eyes during non-PG IOP-lowering treatment.
RESULTS: Significant IOP reductions were observed during PG analogue treatment. There was no significant difference in the frequency of anterior uveitis in those eyes treated with PG analogues and those treated with non-PG agents (p = 0.87, Fisher exact test). None of the 69 uveitic eyes without a previous history of CMO developed this complication. There was no increase in the frequency of visually significant CMO during PG treatment compared with that during non-PG treatment (p = 0.19, Fisher exact test).
CONCLUSION: This study demonstrates that PG analogues are potent topical medications for lowering raised IOP in patients with uveitis and are not associated with increased risk of CMO or anterior uveitis.

PMID 18460537  Br J Ophthalmol. 2008 Jul;92(7):916-21. doi: 10.1136/bj・・・
著者: Nikos N Markomichelakis, Agori Kostakou, Ioannis Halkiadakis, Sonia Chalkidou, Dimitrios Papakonstantinou, Gerasimos Georgopoulos
雑誌名: Graefes Arch Clin Exp Ophthalmol. 2009 Jun;247(6):775-80. doi: 10.1007/s00417-009-1036-3. Epub 2009 Jan 28.
Abstract/Text BACKGROUND: To compare the efficacy and safety of latanoprost against a fixed combination of dorzolamide and timolol in eyes with elevated intraocular pressure (IOP) or glaucoma and anterior or intermediate uveitis.
METHODS: Fifty-eight patients with anterior or intermediate uveitis and elevated IOP or glaucoma presented or followed up in the Ocular Inflammation and Immunology Service of General Hospital of Athens were randomly assigned to receive treatment either with latanoprost (30) or with dorzolamide/timolol (28). The main outcome measures were inflammatory relapses and IOP response to treatment.
RESULTS: Ten patients (34%) in the latanoprost group and sixteen patients (57%) in the dorzolamide/timolol group experienced relapses of anterior uveitis (p = 0.93). There was no statistical difference between the two groups in respect of inflammatory relapses (p = 0.21). Twenty-one patients were followed up before starting latanoprost. The number of recurrences of anterior uveitis per patient per year before treatment with latanoprost was 0.82 +/- 1.2. The rate of relapses per patient per year after starting latanoprost was 0.39 +/-0.7 for these patients (p = 0.038). After 1 year of treatment, intraocular pressure was dropped from 27.8 +/- 8.4 mmHg to 18.6 +/- 5.3 mmHg (p < 0.001) in the latanoprost group and from 28.2 +/-8.1 mmHg to 22.6 +/-10.1 mmHg (p < 0.001) in the dorzolamide/timolol group. Four patients during treatment with latanoprost and five patients during treatment with dorzolamide/timolol developed macular edema.
CONCLUSION: Latanoprost is safe and equally effective to a fixed combination of dorzolamide and timolol in the treatment of uveitic glaucoma.

PMID 19184081  Graefes Arch Clin Exp Ophthalmol. 2009 Jun;247(6):775-8・・・
著者: D J Forster, N A Rao, R A Hill, Q H Nguyen, G Baerveldt
雑誌名: Ophthalmology. 1993 May;100(5):613-8.
Abstract/Text BACKGROUND: The Vogt-Koyanagi-Harada syndrome is a bilateral panuveitis associated with neurologic and dermatologic manifestations.
METHODS: The authors reviewed the charts of all patients with Vogt-Koyanagi-Harada syndrome seen at their institution over the past decade to determine the incidence of glaucoma, as well as the results of medical and surgical therapy for glaucoma, in this group of patients.
FINDINGS: Of 42 patients diagnosed with Vogt-Koyanagi-Harada syndrome, evidence of glaucoma requiring either medical or surgical intervention occurred in 16 patients (38.1%). Of these, nine (56.3%) had open-angle glaucoma and seven (43.7%) had angle-closure secondary to pupillary block. In 5 (31.3%) of the 16 patients, medical therapy alone was sufficient to control intraocular pressure. Eleven patients (68.7%) required surgical intervention, consisting of laser iridotomy, surgical iridectomy, trabeculectomy with or without 5-fluorouracil, and/or Molteno implantation.
CONCLUSION: The relative success of each of these procedures in this group of patients is discussed. Glaucoma is a common complication in the Vogt-Koyanagi-Harada syndrome, and one that is often difficult to control.

PMID 8098519  Ophthalmology. 1993 May;100(5):613-8.
著者: A Kishi, N Nao-i, A Sawada
雑誌名: Am J Ophthalmol. 1996 Nov;122(5):735-7.
Abstract/Text PURPOSE: We studied a case of Vogt-Koyanagi-Harada syndrome with transient shallow anterior chamber and increased intraocular pressure as initial manifestations.
METHODS: We examined the patient using ultrasound biomicroscopy and speculated on the mechanisms of increased intraocular pressure.
RESULTS: Ultrasound biomicroscopic examinations revealed the swollen ciliary body with anterior rotation and supraciliary space at the time of increased intraocular pressure.
CONCLUSIONS: We confirmed that the swollen ciliary body with anterior rotation and supraciliary space caused transient angle-closure glaucoma in this patient with Vogt-Koyanagi-Harada syndrome.

PMID 8909219  Am J Ophthalmol. 1996 Nov;122(5):735-7.
著者: S Parmaksiz, N Yüksel, V L Karabas, B Ozkan, G Demirci, Y Caglar
雑誌名: Eur J Ophthalmol. 2006 Jan-Feb;16(1):73-80.
Abstract/Text PURPOSE: To compare the intraocular pressure (IOP) lowering effect and safety of latanoprost, travoprost given every evening, and the fixed combination dorzolamide + timolol (DTFC) given twice daily in pseudoexfoliation glaucoma (PXG).
METHODS: This randomized, prospective, investigator-masked study has been conducted with 50 PXG patients. Patients were assigned to one of three groups: travoprost 0.004%, fixed combination of dorzolamide 2%+timolol 0.5%, or latanoprost 0.005% for 6 months. At baseline and 0.5, 1, 2, 3, 4, 5, and 6 months of therapy, IOP (8 am, 10 am, 4 pm), blood pressures, and pulse rates were measured, and ophthalmologic examination was performed. The side effects were recorded at each visit.
RESULTS: Forty-two of the 50 patients initially enrolled completed this study. Withdrawn patients included one (latanoprost) for lack of efficacy, five (three travoprost, one latanoprost, one DTFC) for adverse events, and two (one latanoprost, one DTFC) for loss of follow-up. Each of the three drugs considerably reduced the IOP in PXG cases throughout the 6 months. Mean IOP reduction at 6 months was -9.3+/-2.9 mmHg in the travoprost group, -8.2+/-1.2 mmHg in the latanoprost group, and 11.5+/-3.3 mmHg in the DTFC group. Comparing the groups, DTFC is more effective than latanoprost and travoprost in lowering IOP (p<0.05). There was no difference between travoprost and latanoprost. The most common treatment-related adverse event was conjunctival hyperemia. Intensity of ocular hyperemia was greater in the travoprost group compared with the latanoprost and DTFC groups (p<0.05). There were no significant effects on systemic safety parameters.
CONCLUSIONS: The results demonstrated that DTFC is more effective in reducing IOP than latanoprost and travoprost. Latanoprost and travoprost had similar ocular hypotensive effects in patients with PXG. All three drugs were well tolerated; there were fewer ocular side effects attributable in the latanoprost group.

PMID 16496249  Eur J Ophthalmol. 2006 Jan-Feb;16(1):73-80.
著者: Anastasios G P Konstas, Vassilios P Kozobolis, Ioannis E Katsimpris, Kostantinos Boboridis, Stavrenia Koukoula, Jessica N Jenkins, William C Stewart
雑誌名: Ophthalmology. 2007 Apr;114(4):653-7. doi: 10.1016/j.ophtha.2006.07.064. Epub 2006 Dec 29.
Abstract/Text OBJECTIVE: To evaluate 24-hour intraocular pressure (IOP) efficacy of latanoprost versus travoprost, each given every evening, in exfoliative glaucoma patients.
DESIGN: Prospective, observer-masked, crossover comparison.
PARTICIPANTS: Forty patients with exfoliation glaucoma.
METHODS: Patients with a pressure of >24 mmHg were randomized to latanoprost or travoprost for an 8-week treatment period after a 6-week medicine-free period. Patients were then switched to the opposite treatment for the second period. At untreated baseline and at the end of each treatment period the IOP was measured at 6 am, 10 am, 2 pm, 6 pm, 10 pm, and 2 am.
MAIN OUTCOME MEASURE: Diurnal IOP.
RESULTS: The mean 24-hour IOP was 25.1+/-2.5 mmHg at baseline, 17.8+/-2.1 mmHg on latanoprost, and 17.3+/-2.2 mmHg on travoprost (P = 0.001). Individual time points were similar between treatments, except at 6 pm when travoprost provided lower IOP (16.7+/-2.6 vs 17.9+/-2.5 mmHg, P<0.001). Adverse events showed more conjunctival hyperemia with travoprost (n = 15) than latanoprost (n = 6; P = 0.03).
CONCLUSIONS: Latanoprost and travoprost both significantly reduce the 24-hour IOP from baseline in exfoliative glaucoma, but travoprost may demonstrate a greater hypotensive efficacy in the late afternoon.

PMID 17197028  Ophthalmology. 2007 Apr;114(4):653-7. doi: 10.1016/j.op・・・
著者: A G P Konstas, N Mylopoulos, C H Karabatsas, V P Kozobolis, S Diafas, P Papapanos, N Georgiadis, W C Stewart
雑誌名: Eye (Lond). 2004 Sep;18(9):893-9. doi: 10.1038/sj.eye.6701345.
Abstract/Text AIMS: To compare the diurnal intraocular pressure (IOP) efficacy and safety of timolol vs latanoprost in subjects with exfoliation glaucoma (XFG).
METHODS: A 3-month prospective, single-masked, active-controlled, parallel comparison performed in six centres in Greece that randomized subjects in a 1 : 1 ratio to either latanoprost in the evening (2000 hours) and placebo in the morning (0800 hours), or timolol twice daily (0800 and 2000 hours).
RESULTS: In all, 103 subjects completed the study. After 3 months of chronic dosing, the latanoprost group exhibited a trend to a greater diurnal IOP reduction from an untreated baseline (24.9+/-3.2-17.4+/-2.9) compared with timolol (24.7+/-2.8-18.3+/-1.9 mmHg) (P=0.07). Latanoprost showed a significantly greater IOP reduction at 0800 hours (-8.5 vs -6.0 mm Hg for timolol, P<0.0001) whereas no difference was observed between the two medications at 1000, 1400, and 2000 hours after a Bonferroni Correction. In addition, latanoprost demonstrated a narrower range of diurnal IOP (2.4) than timolol (3.2 mmHg)(P=0.0017). Safety was similar between groups, except there was more conjunctival hyperaemia with latanoprost (n=8) than timolol (n=1)(P=0.01).
CONCLUSIONS: This study suggests that latanoprost provides a statistically lower 08:00-hour IOP and better range of IOP than timolol in the treatment of XFG glaucoma.

PMID 15002024  Eye (Lond). 2004 Sep;18(9):893-9. doi: 10.1038/sj.eye.6・・・
著者: A Alm, I Widengård, D Kjellgren, M Söderström, B Friström, A Heijl, J Stjerschantz
雑誌名: Br J Ophthalmol. 1995 Jan;79(1):12-6.
Abstract/Text The long term effects of two dose regimens of latanoprost (PhXA41) administered to eyes concomitantly treated with timolol which had not adequately been controlled by timolol alone were compared. A total of 50 patients, 17 with primary open angle glaucoma and 33 with capsular glaucoma, were recruited from five clinics. All had glaucomatous visual field defects and an intraocular pressure (IOP) of at least 22 mm Hg despite treatment with 0.5% timolol twice daily. Patients were randomised to two treatment groups. In one group 0.006% latanoprost was given twice daily, in the other group placebo was given at 8 am and latanoprost at 8 pm for 3 months, with concomitant timolol treatment in both groups. Average daytime IOP (mean (SD)) at baseline (on timolol alone) and after 4 and 12 weeks' treatment was 24.8 (3.6), 16.8 (4.3), and 15.7 (2.4) mm Hg respectively with once daily application of latanoprost and 24.9 (2.9), 18.1 (3.0), and 18.0 (3.6) mm Hg respectively with latanoprost twice daily. No clinically significant side effects were observed during treatment. Latanoprost causes a marked and sustained IOP reduction in eyes which are also being treated with timolol. Latanoprost given once daily is at least as effective and probably superior to a twice daily dose regimen.

PMID 7880782  Br J Ophthalmol. 1995 Jan;79(1):12-6.
著者: C B Camras, A Alm, P Watson, J Stjernschantz
雑誌名: Ophthalmology. 1996 Nov;103(11):1916-24.
Abstract/Text PURPOSE: To determine efficacy and safety of latanoprost, a prostaglandin analog for glaucoma, during 1 year of treatment.
METHODS: After baseline measurements, 0.005% latanoprost was topically applied once daily for 12 months in patients from Scandinavia, the United Kingdom, and the United States who had elevated intraocular pressure (IOP). Diagnoses included ocular hypertension, chronic open-angle glaucoma, exfoliation syndrome, and pigment dispersion syndrome. Treatment was masked for the first 6 months and open-label during the second 6 months.
RESULTS: Of the 272 patients initially enrolled, withdrawals were due to inadequate IOP control (1%), increased iris pigmentation (5%), other ocular problems (3%), systemic medical problems (3%), and nonmedical reasons (14%). Latanoprost significantly (P < 0.0001) reduced diumal IOP from 25.3 +/- 3.0 mmHg (mean +/- standard deviation) at baseline to 17.4 +/- 2.7 mmHg (32% reduction) at 12 months in the 198 patients who completed 1 year of treatment. The IOP reduction was maintained at a consistent level throughout the 12 months without evidence of drift, and was not affected by sex, age, race, or eye color. Overall, latanoprost caused a possible or definite increase in iris pigmentation in 12% of the 272 patients, all of whom had multicolored irides at baseline. One half of these patients with increased pigmentation withdrew before completing 1 year of therapy. Visual field, optic disc cupping, visual acuity, refractive error, conjunctival hyperemia, aqueous flare, anterior chamber cellular response, lens examination, blood pressure, heart rate, blood tests, and urinalysis were not appreciably altered.
CONCLUSION: Latanoprost safely and effectively reduces IOP for 1 year in patients of diverse nationalities, providing further evidence for its usefulness in chronic glaucoma therapy.

PMID 8942890  Ophthalmology. 1996 Nov;103(11):1916-24.
著者: A Heijl, E Strahlman, T Sverrisson, O Brinchman-Hansen, T Puustjärvi, R Tipping
雑誌名: Ophthalmology. 1997 Jan;104(1):137-42.
Abstract/Text PURPOSE: The purpose of the study is to compare the efficacy and safety profile of 2.0% dorzolamide (three times daily) and 0.5% timolol (twice daily) for up to 6 months in patients with glaucoma or ocular hypertension associated with pseudoexfoliation. The additive effects of dorzolamide and timolol in patients requiring add-on therapy also was evaluated.
METHODS: This was a double-masked, randomized, parallel comparison study at 15 Scandinavian sites. One hundred eighty-four patients with pseudoexfoliation and either glaucoma or ocular hypertension who were 21 to 85 years of age were studied. The treatment groups were 2.0% dorzolamide three times daily and 0.5% timolol maleate twice daily.
RESULTS: At 6 months, the mean percent reduction in intraocular pressure of 2% dorzolamide and 0.5% timolol was 24% and 29%, respectively, at morning peak and 21% and 23%, respectively, at afternoon trough. The additional intraocular pressure-lowering effect of adding 2.0% dorzolamide twice daily to patients receiving timolol was 14% and 15%, at peak and trough, respectively. There were no differences between treatment groups in the incidence of clinical adverse experiences, and dorzolamide was not associated with the systemic adverse effects typically ascribed to the use of oral carbonic anhydrase inhibitors.
CONCLUSION: Two percent dorzolamide (three times daily) was effective and well tolerated in patients with glaucoma or ocular hypertension associated with pseudoexfoliation over the course of 6 months; 0.5% timolol (twice daily) had a greater level of intraocular pressure-lowering activity than did dorzolamide, although the difference between the two treatments became less pronounced during the study period. Finally, 2.0% dorzolamide (twice daily) produced additional lowering of intraocular pressure when given with 0.5% timolol (twice daily).

PMID 9022118  Ophthalmology. 1997 Jan;104(1):137-42.

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