國防醫學院生命科學研究所博士學位論文

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1 (ultrafiltration) - (Na + -K + pump) 11 camp 12 (melatonin) (norepinephrine) % 15 (fluorophotometric study) (negative back control) Leydhecker et al. Shitoz mmhg 10~20 mmhg ( +2 ) : 1. (manometry) 2. (pneuma-tonometry) (telemetry)- 25 4~6 3

2 (congenital) (open-angle) (closed-angle) (primary type) (secondary type) (primary open-angle glaucoma, POAG) (PCAG) (CACG) (neovasculazation) ( 2) 26~29, (biphasic) 30~31 ( 3) (trabeculecotomy) ( 3) ( 4) β- (β-blockers) timolol betaxolol (adrenergic agonists) dipiverine epinephrine clonidine brimonidine pilocarpine 4

3 (carbonic anhydrase inhibitors) acetazolamide dolazolamide ( 5) ( 4) NO (endothelin) NO (angiotensin II coverting enzyme inhibitors, ACEI)- cilazapril quinapril (HT) (CHF) (angiotensin II, Ag II)ACEI kininase II (bradykinin, BK) BK NO (prostaglanidin, PG) 31 Ag II -1(endothelin-1, ET-1) mrna ET-1 ACEI 32 - quinapril Ag II O 2 inos enos NO 32 NO 33 (calcium channel blocker, CCB)- nifedipine verapamil [Ca ++ ] enos cgmp/camp 34 (nitrovasodilators) (nitroglycerin, NTG) NO/cGMP ( 5) Sildenafil (viagra ) phosphodiesterase) cgmp NO 31~34 NSAIDs COX-2 (cyclooxygenase 2) inos Latanoprost (0.005% Xalatan) Isopropyl unoprostone (0.12% Rescula) 35 5

4 8 1. A. ; B. 6

5 (mmol/kg H 2 O) (Na + ) (K + ) (Ca ++ ) (Mg ++ ) (Cl - ) (HCO3 - ) (lactate) (pyruvate) (ascorbate) (urea) (glucose reducing value) (amino-acids) ( ) H 2 O 2 (µm) 24 ~ 69 Glutathione (µm) 1 ~ 10 Ascorbate (mm) 1 Lactoferrin (mg/ml) 2.2 7

6 20 2. A. ; B. 8

7 20 3. A. - (iriocoreal), B. 9

8 4 2. (Open-Angle Glaucoma) (Primary) (Normal-tension) (Juvenile) (Secondary) (Due to angle recession) (Due to aphakia or pseudophakia) (Due to corticosteroid use) (Due to elevated episcleral venous pressure) ( ) (Due to exfoliation (pseudoexfoliation) syndrome) (Due to ghost cells) (Due to hemorrhage) (Due to inflammation)* (Due to iridoschisis)* (Due to phacolytic changes in the lens) (Due to pigment dispersion syndrome) (Closed-Angle Glaucoma) (Primary) (Pupilary-block) (Due to plateau iris syndrome) (Secondary) ( (Due to aqueous misdirection (Malignant glaucoma)) (Due to ciliary -body swelling) (Due to ectopia lentis) (Due to epithelial downgrpwth) Fuch s (Due to Fuch s endothelial dystrophy) (Due to inflammation)* (Due to iridocorneal-endothelial syndrome) (Due to iridoschisis)* (Due to phacomorphic changes in the lens) (Due to posterior polymorphous corneal dystrophy) (Congenital Glaucoma) (Primary) (Primary, associated with a syndrome) (Associated with aniridia) Axenfeld-Rieger (Associated with Axenfeld-Rieger syndrome) (Associated with neurofibromatous syndrome) Peter s (Associated with Peter s anomaly) Sturge-Weber (Associated with Sturge-Weber syndrome) (Secondary) (Due to aphakia) (Due to retinoblastoma) (Due to retinopathy of prematurity) * 10

9 4, * 1. (Adrenergic agonist) 2. (open angle) Epinephrine β 2 Norepinerphrine Dipiverine β- β 1. β2 (β-adrenergic agonist) 2.. (open angle) Isoproterenol Salbutamol β- 1. (β -Adrenergic blockers) β 2, α 2. α (open angle) Timolol (β ) Betaxolol (β 1 ) (closed angle) Carteolol (β ) Levbunolol (β ) α 1 - α 1. α 1 (α 1 -Adrenergic, (closed angle) antagonist) 2. α 1 Prazosin Bunazosin α 2 - α 2 1. (NE), (α 2 -Adrenergic agonist) (open angle) Apraclonidine 2. - Brimonidine 3. cgmp Clonidine 1. (Muscarinic agonist) M 2. (closed angle) Carbachol - Pilocarpine 3., -, Physostigmine, Echothiophate, (Carbonic anhydrase. (closed angle) inhibitors) Acetazolamide ( ) Methazolamide ( ) Dorzolamide ( ) 1. (Hyperosmotic agents) 2. (acute closed- Urea ( ), angle) Glycerol ( ) Mannitol ( ) (Prostaglandins) - ; PGF 2 α (open angle) * (non-selective) 11

10 4, * β-- : (Headache) (Adrenergic agonist) : ( Arrhythmia), (Hyper- Epinephrine 0.5 ~ 1% bid tension), ( Tachycardia). Dipiverine 0.1% bid :,,, β-- : (Lethargy), (Weakness) (β -Adrenergic antagonist) :,,,,, Timolol (β ) 0.25 ~ 0.5% bid,, Betaxolol (β 1 ) 0.5% bid : (Bronchospasm), Carteolol (β ) 1% bid :,,,, Levobunolol (β ) 0.25 ~ 0.5% bid,, : (Cramps),, :, :, α- : (Lethargy), (Fatigue),, (α 1 -Adrenergic antagonist) Prazosin 0.5~1% tid : (Mild decrease in BP) Bunazosin 0.25~0.5% tid :, α 2 - : (Lethargy), (Fatigue),, Apraclonidine 0.5 ~ 1% tid, Brimonidine 0.2% tid : (Mild decrease in BP) Clonidine 0.125% tid :, :,,, (Salivation) (Muscarinic agonist) : Carbachol 0.75~3% tid :, (Pulmonary edema) Pilocarpine 1~4% tid :,, :,,, Echothiophate 0.03~0.25% bid :, Physostigmine 0.25% Oint. tid :, :, (Fatigue),, (Carbonic anhydrase inhibitors) :,, Acetazolaminde ( ) 125~250 mg bid-qid : Methazolaminde ( ) 25~50 mg bid-qid :,,, Dorzolamide 2% tid :, :,,,,,, : :,, (Hyperosmotic agents) Glycerol ( ) 0.7~1.5 gm/kg hs Mannitol ( ) 1.5~2.0 gm/kg hs Urea ( ) 0.5~2.0 gm/kg hs :, :, Latanoprost 0.005% bid :,, *, 12

11 5 (nitrovasodilators) ( ) Isosorbide Dinitrate (60%lactone) a C 6 H 8 N 2 O 8 (MW 236.1) b Insol. in H 2 O; Sol. in EtOH, AcN b Sodium nitrate NaNO 3 (MW 85.1) Sol. in H 2 O; Insol. in n-hexane Nitroglycerin C 3 H 5 N 3 O 9 (MW ) Sol. MeOH, EtOH, sparkle H 2 O Hydralazine C 8 H 8 N 4. HCI (MW 196.6) Insol. in H 2 O; Sol. in EtOH, AcN Minoxidil (sulfate salt) C 9 H 15 N 5 O 4 S (MW 289.3) Insol.in H 2 O; Sol. in EtOH, AcN Sodium Nitroprusside (SNP) c C 5 FeN 6 Na 2 O. 2H 2 O (MW 298) Sol.in H 2 O, EtOH, MeOH, Ace 3-morpholinosydnonimine (SIN-1)Cl C 6 H 10 N 4 O 2 (MW ) Sol. in H 2 O ( > 10 mg/ml) S-nitro-N-acetylpenicillamine (SNAP) C 7 H 12 N 2 O 4 S (MW 220.2) Sol. in DMSO (57.5 mg/ml) Spermine/NO complex (Sper/NO) c C 10 H 26 N 2 O 2 (MW ) Sol. in H 2 O (4.5 mg/ml) (Non-nitrovasodilators) 1. (Calcium channel blockers, CCB) Nifedipine C 17 H 18 N 2 O 6 (MW 343.3) Insol.in H 2 O; Sol.in EtOH, AcN Verapamil HCI C 27 H 38 N 2 O 4 HCI (MW 491.3) Insol.in H 2 O; Sol.in EtOH, AcN 2. II (Angiotension II coverting enzyme inhibitors, ACEI) Captopril (Capoten) a C 9 H 15 NO 3 S (MW 217.3) Sol. in H 2 O, EtOH, MeOH, Ace 3. NMDA Dizocilpine (MK-801) c C 16 H 15 N C 4 H 4 O 4 HCI (MW 491.3) Sol. in DMSO ( >20 mg/ml) 4. NOS (NOS Inhibitor) a Non-selective: L-N w -arginine-methylester(l-name) C 7 H 16 N 4 O 2 (MW 202.2) Sol. in H 2 O, Ace, MeOH Selectives: Aminoquindine (AMG) CH 6 N 4 HCl (MW 110.5) Sol. in H 2 O (Anti-glaucoma agents) Dorzolamide (Trusopt) d C 10 H 16 N 2 O 4 S 3 HCl (MW 360.9) Sol. in H 2 O, EtOH, MeOH Timolol maleate (Timoptol) e C 14 H 21 N 4 O 7 S (MW ) Sol. in H 2 O; store at RT Dipivayl epinephrine (Propine) f C 15 H 14 NO 3 (MW ) Sol. in H 2 O; store at RT Pilocarpine (Isocarpine) g C 11 H 16 N 2 O 2 (MW ) Sol. in H 2 O, EtOH, CHCl 3 Apraclonidine (Iopidine) h C 9 H 11 Cl 3 N 4 (MW ) Sol. in H 2 O Brimonidine (Alphagan) i C 11 H 10 BrN 5.C 4 H 6 O 6 (MW ) Sol. in H 2 O Latanoprost (Xalatan) j C 26 H 40 O 5 (MW ) Sol. in AcN, EA; Insol.in H 2 O Ace.: ; AcN: ; DMSO: ; EA: ; EtOH: ; MeOH: ; RT: a Sigma Co. catalogue (1997) b Merck index (1996) c: RBI Co. catalogue (1998) d carbonic anhydrase inhibitor (MSD ) e β-adrenergic blockers(msd ) f β-adrenergic prodrug (Allergan ) g muscarnic cholinergic agonist (Alcon ) h α 1 -adrenergic prodrug (Alcon ) i α 2 -adrenergic agonist (MSD ) j prostaglandins- F 2 α (Pharmacia & Upjohn ); PDR ophthal. 29 ed. p.216~314 (2001). 13

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0311- 實習生施盈伃 1 *Introduction *Pathogenesis *Epidemiology *Risk factors *Classification *Diagnosis *Therapy *Summary 2 *Optic neuropathy in 1 or both eyes characterized by structural damage to optic nerve associated