老视药物疗法的研究进展

doi:10.3877/cma.j.issn.2095-2007.2023.03.010

老视是指因年龄增长所致的不可逆性生理性调节减弱，并严重影响患者视觉质量的现象。未经恰当矫正的老视是全球人口视力受损的首要因素。近年来，框架眼镜、手术及角膜接触镜等传统矫正方案已不能满足老视人群日益增长的需求，药物治疗老视可能是其新方案。本文中笔者对老视药物的应用现状和发展策略进行综述，旨在比较现有药物的有效性与安全性，并提出未来新药开发的潜在方向。

关键词: 老视, 调节, 药物治疗, 毛果芸香碱, 硫辛酸

Presbyopia is the irreversible loss of the accommodative ability of the eye that occurs due to ageing, which severely affects patients′ visual quality. Globally, presbyopia without proper correction is the primary cause of visual impairment. Despite widespread use of glasses, surgery and contact lens, there has been an increasing demand for novel treatment strategies. Recently, the pharmacological treatments for presbyopia provide an alternative strategy. The current status and evolving strategies of pharmacological approaches to the treatment of presbyopia were reviewed, aiming to compare the safety and efficiency of current therapies and put forward potential drug candidates.

Key words: Presbyopia, Accommodation, Pharmacological treatment, Pilocarpine, Thiocticacid

表1 药物治疗老视不良事件的文献汇总

第一作者	例数(只眼)	年龄(岁)	药物成分	用药后观察时间(h)	随访时间	不良事件及其发生率
Benozzi等^[40]	148(296)	40~60	1%毛果芸香碱和0.1%双氯芬酸钠		2~10年	视野昏暗25%、头痛11%及眼部烧灼感7%
Benozzi等^[39]	910(1820)	48.7±3.7	1%毛果芸香碱和0.1%双氯芬酸钠		1~8年	视野昏暗26%、头痛13%及眼部烧灼感9%
Waring等^[24]	183(366)	49.5±3.8	1.25%毛果芸香碱	10	1个月	头痛14%、视力障碍4%及结膜充血3%
Vargas等^[38]	117(234)	50.2±5.1	0.247%毛果芸香碱为主的多药组合	2		头痛12%
Xu等^[33]	30(60)	40~61	0.1%酒石酸溴莫尼定	8		无
Abdelkader等^[36]	30(30)	50.8±4.6	2.25%卡巴胆碱和0.1%溴莫尼定	10	3个月	头痛10%、眼部烧灼感3%及视野昏暗3%
Abdelkader等^[34]	10(20)	49.7±4.8	3%卡巴胆碱和0.2%溴莫尼定	8		眼部烧灼感10%
	10(20)	49.7±4.8	3%卡巴胆碱	8		眼部烧灼感60%
	10(20)	49.7±4.8	0.2%溴莫尼定	8		眼部烧灼感30%
Abdelkader等^[37]	32(32)	51.1±4.5	2.25%卡巴胆碱和0.2%溴莫尼定	12		无
	25(25)	52.8±3.9	3%卡巴胆碱和0.2%溴莫尼定	12		无
Pepose等^[42]	19(38)	58.1±13.2	1%甲磺酸酚妥拉明	18~20	2周	结膜充血16%、眼痛或烧灼感16%及眼痒5%
Korenfeld等^[41]	34(34)	50.9±3.4	1.5%硫辛酸胆碱酯		3个月	味觉障碍14%、眼痛6%及头痛4%

表1 药物治疗老视不良事件的文献汇总

第一作者	例数(只眼)	年龄(岁)	药物成分	用药后观察时间(h)	随访时间	不良事件及其发生率
Benozzi等^[40]	148(296)	40~60	1%毛果芸香碱和0.1%双氯芬酸钠		2~10年	视野昏暗25%、头痛11%及眼部烧灼感7%
Benozzi等^[39]	910(1820)	48.7±3.7	1%毛果芸香碱和0.1%双氯芬酸钠		1~8年	视野昏暗26%、头痛13%及眼部烧灼感9%
Waring等^[24]	183(366)	49.5±3.8	1.25%毛果芸香碱	10	1个月	头痛14%、视力障碍4%及结膜充血3%
Vargas等^[38]	117(234)	50.2±5.1	0.247%毛果芸香碱为主的多药组合	2		头痛12%
Xu等^[33]	30(60)	40~61	0.1%酒石酸溴莫尼定	8		无
Abdelkader等^[36]	30(30)	50.8±4.6	2.25%卡巴胆碱和0.1%溴莫尼定	10	3个月	头痛10%、眼部烧灼感3%及视野昏暗3%
Abdelkader等^[34]	10(20)	49.7±4.8	3%卡巴胆碱和0.2%溴莫尼定	8		眼部烧灼感10%
	10(20)	49.7±4.8	3%卡巴胆碱	8		眼部烧灼感60%
	10(20)	49.7±4.8	0.2%溴莫尼定	8		眼部烧灼感30%
Abdelkader等^[37]	32(32)	51.1±4.5	2.25%卡巴胆碱和0.2%溴莫尼定	12		无
	25(25)	52.8±3.9	3%卡巴胆碱和0.2%溴莫尼定	12		无
Pepose等^[42]	19(38)	58.1±13.2	1%甲磺酸酚妥拉明	18~20	2周	结膜充血16%、眼痛或烧灼感16%及眼痒5%
Korenfeld等^[41]	34(34)	50.9±3.4	1.5%硫辛酸胆碱酯		3个月	味觉障碍14%、眼痛6%及头痛4%

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Advances in pharmacological treatments for prebyopia

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Advances in pharmacological treatments for prebyopia