Montelukast可以有效地治疗与气喘有关的春季型角膜结膜炎


  2003年5月22日—发表于5月号Archives of Ophthalmology的小型研究报告指出,Montelukast 可以有效地治疗与气喘有关的春季型角膜结膜炎( VKC ),根据这些研究结果,研究人员建议,继续进行随机化的试验以确认研究结果。
  
  位于意大利罗马生物医学大学的Alessandro Lambiase博士表示,VKC是一种结膜的双侧慢性发炎,其特征为充血、结膜水肿、畏光、形成丝状及粘性分泌物,上眼睑也会出现巨大的乳突。在超过 50%的患者中,眼睛是发生过敏性发炎的唯一目标器官,在195名受试的患者中,有41.5%的春季型角膜结膜炎与其它过敏性疾病有关,主要是气喘。
  
  在加入这项研究后,12名患有春季型角膜结膜炎和气喘的患者停止使用一般的眼药水或停止全身性的治疗共7天的时间。
  
  在治疗15天后,10位患者中有8位的症状减轻了,包括烧灼感、流泪、畏光、分泌物及发红,与医师有关的充血、分泌物及结膜水肿也显著地减少了,这些症状的改善与眼泪中的leukotriene B4显著增加及尿液中的leukotriene E4显著减少有关。但是很可惜的这次的研究限制是试验规模过小及这是一项公开性试验。
  
  以montelukast治疗15天,便使春季型角膜结膜炎的气喘患者之眼睛症状显著地减轻,因此强烈地建议我们进行双盲、安慰剂-控制组研究,以确认这种新疗法治疗引起春季型角膜结膜炎之其它过敏反应的效果,例如遗传性过敏角膜结膜炎和花粉热结膜炎持续的发炎反应。

Montelukast Effective in Verna

By Laurie Barclay, MD
Medscape Medical News

May 22, 2003 — Montelukast effectively treats vernal keratoconjunctivitis (VKC) associated with asthma, according to the results of a small trial published in the May issue of the Archives of Ophthalmology. Based on these findings, the investigators now recommend randomized trials.

"VKC is a chronic bilateral inflammation of the conjunctiva characterized by hyperemia, chemosis, photophobia, filamentous and sticky mucous discharge, and giant papillary hypertrophy of the upper tarsal conjunctiva," write Alessandro Lambiase, MD, from the University "Campus Bio-Medico" in Rome, Italy, and colleagues. "In more than 50% of patients the eye is the only target organ of the allergic inflammation, while in 41.5% of a survey of 195 patients, VKC was associated with other allergic diseases, mainly asthma."

After enrollment in this pilot study, 12 patients with vernal keratoconjunctivitis and asthma discontinued topical eyedrops or any systemic treatment for at least seven days before montelukast treatment.

After 15 days of treatment, eight of 10 patients evaluated reported a reduction in symptoms, including burning, tearing, photophobia, secretion, and redness, while physician-rated hyperemia, secretion, and chemosis also decreased significantly. These improvements were associated with a significant increase in leukotriene B4 in tears and a significant decrease in leukotriene E4 in urine.

Study limitations are those inherent in a small open trial.

"The significant and persistent reduction of ocular signs and symptoms in asthmatic patients with [VKC] treated for 15 days with montelukast strongly suggests the need for double-masked placebo-controlled trials to confirm the potential of this new treatment in [VKC and in] other allergic conjunctivitis, such as atopic keratoconjunctivitis and hay fever conjunctivitis with persistent inflammation and late-phase reaction," the authors write.

Merck & Co. Inc. supported this study by an unrestricted grant. The authors did not report any significant financial disclosures.

Arch Ophthalmol. 2003;121: 615-620

Reviewed by Gary D. Vogin, MD

    
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