■綜説
緑内障に対する眼圧下降治療の現状と限界
中元 兼二
日本医科大学眼科
Current Status and Limitations of Intraocular Pressure-lowering Therapy for Glaucoma
Kenji Nakamoto
Department of Ophthalmology, Nippon Medical School
Currently, the only reliable treatment for glaucoma is intraocular pressure (IOP)-lowering therapy. Guidelines recommend setting a target IOP for each patient prior to starting treatment. Previous randomized controlled study results have shown that the lower the target IOP is set, the greater the suppression of glaucoma progression. In addition to lowering the mean clinical IOP, there also needs to be increased attention to IOP fluctuations, such as 24-hour and long-term IOP fluctuations. Although first-line drugs normally administered include prostanoid FP receptor agonists (FP agonists), EP2 receptor agonists (EP2 agonists), which do not lead to the periorbitopathy (PAP) associated with prostaglandin, are sometimes prescribed in Japan as first-line drugs. From an adherence viewpoint, the second-line drug is often changed to a fixed combination eye drop, with a fixed combination of an FP receptor agonist and a β-blocker. The IOP-lowering effects of glaucoma eye drops involve specific 24-hour variations that are dependent on the type of drug. While β-blockers have less nighttime IOP-lowering effects, FP agonists, the EP2 agonist, carbonic anhydrase inhibitors and ROCK inhibitors exhibit significant 24-h IOP-lowering effects. Unfortunately, even with multidrug therapy, the maximum 24-hour IOP tends to occur in the middle of the night. However, the use of selective laser trabeculoplasty and physiological outflow pathway reconstruction has been shown to not only reduce daytime IOP-lowering, but also nighttime IOP-lowering and 24-hour IOP fluctuations. In addition, trabeculectomy combined with mitomycin C has been shown to exhibit the greatest reduction in the preoperative mean IOP and 24-hour IOP fluctuation. Nevertheless, as the IOP is known to clinically increase postoperatively, multidrug therapy often needs to be restarted, thereby leading to increases in the 24-hour IOP fluctuations that will ultimately reduce the quality of the IOP-lowering effect.
日医大医会誌 2023; 19(2), 156-163
Key words
glaucoma, intraocular pressure, intraocular pressure-lowering therapy, 24-hour intraocular pressure, fluctuation of intraocular pressure
Correspondence to
Kenji Nakamoto, MD, PhD, Department of Ophthalmology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
E-mail：makken45@nms.ac.jp
受付：2022年10月10日 受理：2022年10月18日 |
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