Turkiye Klinikleri Journal of Ophthalmology

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Erken Evre Primer Açık Açılı Glokom Hastalarında Topikal Antiglokomatözlerin Pupil Fonksiyonlarına Etkisi: Kesitsel Araştırma
The Effect of Topical Antiglaucoma Agents on Pupil Function in Patients with Early-Stage Primary Open-Angle Glaucoma: A Cross-Sectional Research
Büşra Dilara YILDIRIM ERDALa , Serdar BAYRAKTARa , Gözde HONDURb , Emine MALKOÇ ŞENc
aAnkara Etlik Şehir Hastanesi, Göz Hastalıkları Kliniği, Ankara, Türkiye
bSağlık Bilimleri Üniversitesi Ankara Ulucanlar Göz Eğitim ve Araştırma Hastanesi, Göz Hastalıkları Kliniği, Ankara, Türkiye
cDünya Göz Hastanesi, Göz Hastalıkları Kliniği, Ankara, Türkiye
Turkiye Klinikleri J Ophthalmol. 2025;34(3):128-35
doi: 10.5336/ophthal.2025-108282
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışmanın amacı, erken evre primer açık açılı glokom (PAAG) hastalarında brimonidin, karteolol ve latanoprost göz damlaları ile uzun dönem tedavinin pupil fonksiyonları üzerindeki etkilerini karşılaştırmaktır. Gereç ve Yöntemler: Bu kesitsel ve gözlemsel çalışmada, PAAG tanısı almış ve ortalama 14,2±4,6 ay (6-24 ay) antiglokomatöz ajan kullanan 94 erken evre glokom hastasının (brimonidin %0,15, n=28; karteolol %2, n=30; latanoprost %0,005, n=36) 94 gözü ile yaş ve cinsiyet uyumlu 35 sağlıklı katılımcının 35 gözü karşılaştırıldı. Hastaların statik ve dinamik pupil fonksiyonları otomatik pupillometri cihazı ile değerlendirildi. Statik pupillometri ile yüksek fotopik (100 cd/m²), düşük fotopik (10 cd/m²), mezopik (1 cd/m²) ve skotopik (0,1 cd/m²) ışık koşullarındaki pupil çapları elde edildi. Dinamik pupillometri ile kontraksiyon amplitüdü, latansı, süresi ve hızı ile dilatasyon latansı, süresi ve amplitüdü değerlendirildi. Bulgular: Brimonidin kullanan grupta, mezopik ve skotopik pupil çapı, karteolol, latanoprost ve kontrol grubuna göre anlamlı olarak küçüktü (sırasıyla p=0,007 ve p<0,001). Ayrıca, brimonidin grubunda dinlenim çapı ve kontraksiyon amplitüdü de anlamlı şekilde azalmıştı (sırasıyla p<0,001 ve p=0,005). Diğer statik ve dinamik pupillometri parametrelerinde gruplar arasında anlamlı fark gözlemlenmedi. Pupillometri parametreleri ile yaş, ortalama peripapiller retina sinir lifi kalınlığı ve görme alanındaki ortalama sapma değerleri arasında korelasyon bulunmadı. Sonuç: Erken evre PAAG tedavisinde brimonidin %0,15'in uzun dönem kullanımı, özellikle karanlık veya düşük aydınlatma koşullarında pupil çapında klinik olarak anlamlı bir azalmaya neden olmaktadır. Karteolol %2 ve latanoprost %0,005 kullanımında ise böyle bir etki gözlenmemiştir. Bu bulgular, glokom hastalarında brimonidin kullanımının antimidriyatik etkisi sayesinde özellikle gece görüşü gibi düşük ışıklı ortamlarda uyumu artırabileceğini göstermektedir.

Anahtar Kelimeler: Brimonidin tartrat; karteolol; latanoprost; primer açık açılı glokom; pupiller refleks
ABSTRACT
 Objective: To compare the effects of long-term treatment with brimonidine, carteolol, and latanoprost on pupillary functions in patients with earlystage primary open-angle glaucoma (POAG). Material and Methods: This cross-sectional, observational study included 94 eyes of 94 patients diagnosed with early-stage POAG who had been using antiglaucomatous agents for a mean 14.2±4.6 months (6-24 months) (brimonidine 0.15%, n=28; carteolol 2%, n=30; latanoprost 0.005%, n=36). A control group of 35 eyes from 35 age- and sexmatched healthy participants was also included. Static and dynamic pupillary functions were evaluated using an automatic pupillometry device. Pupil diameters under high photopic (100 cd/m²), low photopic (10 cd/m²), mesopic (1 cd/m²), and scotopic (0.1 cd/m²) light conditions were measured using static pupillometry. Dynamic pupillometry assessed contraction amplitude, latency, duration, and speed, as well as dilation latency, duration, and amplitude. Results: Mesopic and scotopic pupil diameters were significantly smaller in the brimonidine group, than those in the carteolol, latanoprost, and control groups (p=0.007 and p<0.001, respectively). Additionally, the resting pupil diameter and contraction amplitude were significantly reduced in the brimonidine group (p<0.001 and p=0.005, respectively). No significant differences were observed among the groups in other static and dynamic pupillometry parameters. Furthermore, no correlation was found between pupillometry parameters and age, mean peripapillary retinal nerve fiber thickness, or mean deviation values in the visual field. Conclusion: Long-term use of brimonidine 0.15% in the treatment of early-stage POAG results in a clinically significant decrease in pupil diameter, particularly in dark or low-light conditions. No similar effect was observed with carteolol 2% or latanoprost 0.005%. These findings suggest that brimonidine use in glaucoma patients may enhance compliance, especially in low-light environments such as night vision, due to its anti-mydriatic effect.

Keywords: Brimonidine tartrate; carteolol; latanoprost; primary open-angle glaucoma; pupillary reflex
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