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Kahook MY, Rapuano CJ, Messmer EM, Radcliffe NM, Galor A, Baudouin C. Preservatives and ocular surface disease: A review. Ocul Surf 2024; 34:213-224. [PMID: 39098762 DOI: 10.1016/j.jtos.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/15/2024] [Accepted: 08/01/2024] [Indexed: 08/06/2024]
Abstract
Ocular surface disease (OSD) is a complex condition that can cause a range of symptoms (e.g, dryness, irritation, and pain) and can significantly impact the quality of life of affected individuals. Iatrogenic OSD, a common finding in patients with glaucoma who receive chronic therapy with topical ocular antihypertensive drugs containing preservatives such as benzalkonium chloride (BAK), has been linked to damage to the ocular surface barrier, corneal epithelial cells, nerves, conjunctival goblet cells, and trabecular meshwork. Chronic BAK exposure activates inflammatory pathways and worsens symptoms, compromising the success of subsequent filtration surgery in an exposure-dependent manner. In eyes being treated for glaucoma, symptomatic treatment of OSD may provide some relief, but addressing the root cause of the OSD often necessitates reducing or, ideally, eliminating BAK toxicity. Strategies to decrease BAK exposure in patients with glaucoma encompass the use of preservative-free formulations or drugs with alternative and less toxic preservatives such as SofZia®, Polyquad, potassium sorbate, or Purite®. Though the benefits of these alternative preservatives are largely unproven, they might be considered when financial constraints prevent the use of preservative-free versions. For patients receiving multiple topical preserved drugs, the best practice is to switch to nonpreserved equivalents wherever feasible, regardless of OSD severity. Furthermore, nonpharmacological approaches, including laser or incisional procedures, should be considered. This review explores the effects of BAK on the ocular surface and reviews strategies for minimizing or eliminating BAK exposure in patients with glaucoma in order to significantly improve their quality of life and prevent complications associated with chronic exposure to BAK.
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Affiliation(s)
- Malik Y Kahook
- Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, United States.
| | | | - Elisabeth M Messmer
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Nathan M Radcliffe
- New York Eye and Ear Infirmary of Mount Sinai, New York, NY, United States; New York Eye Surgery Center, The Bronx, New York, United States
| | - Anat Galor
- Ophthalmology, VA Miami Healthcare System, Miami, FL, United States; Ophthalmology, University of Miami Health System Bascom Palmer Eye Institute, Miami, FL, United States
| | - Christophe Baudouin
- Paris-Saclay, Versailles Saint Quentin University, Paris, Île-de-France, France; Centre Hospitalier National D'Ophtalmologie des Quinze-Vingts, IHU ForeSight, Paris, Île-de-France, France
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Kandarakis S, Papadopoulos AP, Roussopoulos G, Georgopoulos E, Chung Y, Doumazos L, Baek A, Paizi NI, Shin H, Papadopoulos PA. COMfort Eye Trial (COMET) results - a non-inferiority, randomized, investigator-masked, two-parallel group, phase III clinical trial, to evaluate the efficacy and safety of a preservative free formulation of latanoprost versus a reference drug (Xalatan®) in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT). Expert Opin Drug Saf 2024; 23:743-754. [PMID: 37674345 DOI: 10.1080/14740338.2023.2252341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
AIM To prove non-inferiority of preservative-free (PF) latanoprost versus benzalkonium chloride (BAK) containing latanoprost in lowering intraocular pressure (IOP) in primary open-angle glaucoma (POAG) or ocular hypertension (OHT) patients. DESIGN AND METHODS This phase III, randomized, investigator-masked trial primarily aimed to demonstrate non-inferiority of YSLT PF latanoprost 50 μg/ml (Yonsung GmbH) to latanoprost (Xalatan®) 50 μg/ml (Pfizer) in reducing IOP from Baseline to Week 12. Secondary aims included conjunctival hyperemia evaluation and difference in ocular comfort levels. Total 130 patients with POAG or OHT were enrolled and randomized (1:1 ratio) to receive YSLT or latanoprost, instilling eye drops daily for 12 weeks. RESULTS At Week 12, mean diurnal IOP reduction was -7.67 ± 2.104 mmHg for YSLT PF latanoprost and -7.77 ± 2.500 for latanoprost. The 97.5% confidence interval of between-treatment group difference in IOP reduction from Baseline to Week 12 was [-0.846, +∞), not crossing the non-inferiority margin of -1.5 mmHg. A low incidence of mild topical treatment emergent adverse events (TEAEs) was observed in both groups, while no serious TEAEs were reported. CONCLUSIONS YSLT eye drops demonstrated non-inferiority to latanoprost in reducing IOP. Both products were well tolerated without serious TEAEs reported.
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Affiliation(s)
- Stylianos Kandarakis
- First Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Youngsik Chung
- R&D center, Yonsung Fine Chemicals Co., Ltd. / YS Life Science Co., Ltd, Suwon-si, South Korea
| | - Leonidas Doumazos
- First Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Areum Baek
- R&D center, Yonsung Fine Chemicals Co., Ltd. / YS Life Science Co., Ltd, Suwon-si, South Korea
| | | | - Hyunik Shin
- R&D center, Yonsung Fine Chemicals Co., Ltd. / YS Life Science Co., Ltd, Suwon-si, South Korea
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Kolko M, Gazzard G, Baudouin C, Beier S, Brignole-Baudouin F, Cvenkel B, Fineide F, Hedengran A, Hommer A, Jespersen E, Messmer EM, Murthy R, Sullivan AG, Tatham AJ, Utheim TP, Vittrup M, Sullivan DA. Impact of glaucoma medications on the ocular surface and how ocular surface disease can influence glaucoma treatment. Ocul Surf 2023; 29:456-468. [PMID: 37302545 DOI: 10.1016/j.jtos.2023.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/13/2023]
Affiliation(s)
- Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark; Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Gus Gazzard
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK; UCL Institute of Ophthalmology, London, UK; NIHR-Moorfields Biomedical Research Centre, London, UK
| | - Christophe Baudouin
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France; Université Paris-Saclay, Versailles-Saint-Quentin-en-Yvelines, Paris, France; Institut de la Vision, Sorbonne Université, Paris, France
| | - Sofie Beier
- Royal Danish Academy - Architecture, Design, Conservation, Copenhagen, Denmark
| | - Françoise Brignole-Baudouin
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France; Institut de la Vision, Sorbonne Université, Paris, France; Faculté de Pharmacie, Paris Cité université, Paris, France
| | - Barbara Cvenkel
- Department of Ophthalmology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Fredrik Fineide
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Anne Hedengran
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark; Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Anton Hommer
- Department of Ophthalmology, HERA Hospital, Vienna, Austria
| | | | | | | | | | - Andrew J Tatham
- Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, Edinburgh, UK
| | - Tor Paaske Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
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Fineide F, Lagali N, Adil MY, Arita R, Kolko M, Vehof J, Utheim TP. Topical glaucoma medications – Clinical implications for the ocular surface. Ocul Surf 2022; 26:19-49. [DOI: 10.1016/j.jtos.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/25/2022]
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Romano D, De Ruvo V, Fogagnolo P, Farci R, Rossetti LM. Inter-Eye Comparison of the Ocular Surface of Glaucoma Patients Receiving Surgical and Medical Treatments. J Clin Med 2022; 11:jcm11051238. [PMID: 35268329 PMCID: PMC8910944 DOI: 10.3390/jcm11051238] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Ocular surface frequently affects glaucoma patients. In this paper we aimed at evaluating the impact of glaucoma surgery on the ocular surface of patients who received unilateral trabeculectomy. Methods: 26 consecutive patients successfully treated with trabeculectomy on one eye (Trab Eye) and under control with topical treatments on the fellow eye (Med Eye) were included in this observational study. They received IDEEL and OSDI questionnaires, Tear Film Osmolarity (TFO), grading of conjunctival hyperemia, fluorescein tear break-up time (tBUT), grading of corneal staining and Schirmer test. Results: IDEEL and OSDI scores were 48 ± 38 and 11 ± 12, respectively, with moderate correlation (r = 0.50, p = 0.03). Compared with Med eyes, Trab Eyes had higher tBUT (6.5 ± 3.5 vs. 5.1 ± 2.7 s, p = 0.004), lower conjunctival hyperemia (0.8 ± 0.9 and 1.7 ± 1.1 respectively, p < 0.001) and lower corneal staining (0.3 ± 0.5 and 0.6 ± 0.5, respectively, p = 0.03). Correlation between corneal staining and conjunctival hyperemia was 0.55 in Trab Eyes (p = 0.01) and 0.44 in Med Eyes (p > 0.05). Patients with bilateral corneal staining had had threefold worse questionnaire scores (p < 0.05). The duration of treatment and the daily exposure to preservatives did not directly affect OS parameters in this cohort of patients. Conclusions: Patients receiving successful trabeculectomy showed better OS homeostasis (higher TBUT, lower grading of conjunctival hyperemia and corneal staining) than fellow medically treated eyes. Presence of corneal epithelial damage in both eyes is the factor more consistently affecting questionnaire scores.
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Affiliation(s)
- Dario Romano
- Eye Clinic, ASST Santi Paolo e Carlo—San Paolo Hospital, University of Milan, 20143 Milan, Italy; (D.R.); (V.D.R.); (L.M.R.)
| | - Valentino De Ruvo
- Eye Clinic, ASST Santi Paolo e Carlo—San Paolo Hospital, University of Milan, 20143 Milan, Italy; (D.R.); (V.D.R.); (L.M.R.)
| | - Paolo Fogagnolo
- Eye Clinic, ASST Santi Paolo e Carlo—San Paolo Hospital, University of Milan, 20143 Milan, Italy; (D.R.); (V.D.R.); (L.M.R.)
- Department of Health Science, University of Milan, 20146 Milan, Italy;
- Correspondence:
| | - Roberta Farci
- Department of Health Science, University of Milan, 20146 Milan, Italy;
| | - Luca Mario Rossetti
- Eye Clinic, ASST Santi Paolo e Carlo—San Paolo Hospital, University of Milan, 20143 Milan, Italy; (D.R.); (V.D.R.); (L.M.R.)
- Department of Health Science, University of Milan, 20146 Milan, Italy;
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Sedlak L, Świerczyńska M, Borymska W, Zych M, Wyględowska-Promieńska D. Impact of dorzolamide, benzalkonium-preserved dorzolamide and benzalkonium-preserved brinzolamide on selected biomarkers of oxidative stress in the tear film. BMC Ophthalmol 2021; 21:319. [PMID: 34470600 PMCID: PMC8411550 DOI: 10.1186/s12886-021-02079-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/14/2021] [Indexed: 11/26/2022] Open
Abstract
Background Long-term use of topical, especially benzalkonium chloride (BAC)-preserved, antiglaucoma medications can cause a negative impact on the ocular surface. The aim of the study was to assess the effect of topical carbonic anhydrase inhibitors (CAIs) on selected oxidative stress biomarkers in the tear film. Methods The patients were divided into four sex-matched groups: group C (n = 25) – control group – subjects who did not use topical antiglaucoma medications, group DL (n = 14) – patients using preservative-free dorzolamide, group DL + BAC (n = 16) – patients using topical BAC-preserved dorzolamide, group BL + BAC (n = 17) – patients using BAC-preserved brinzolamide. Subjects in all the study groups have been using the eye drops two times daily for 6–12 months. The oxidative stress biomarkers in the tear film samples were measured: total protein (TP) concentration, advanced oxidation protein products (AOPP) content, total sulfhydryl (-SH) groups content, the activity of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), as well as Total Oxidant Status (TOS), Total Antioxidant Response (TAR), and Oxidative Stress Index (OSI). Results The advanced oxidation protein products content, Total Oxidant Status as well as superoxide dismutase and catalase activities in the group DL + BAC and BL + BAC were higher in comparison with the group C. The total sulfhydryl groups content was lower in the group DL + BAC and BL + BAC when compared to group C. Oxidative Stress Index was higher in the groups DL + BAC and BL + BAC in comparison with the groups DL and C. Conclusions Use of topical benzalkonium chloride-preserved carbonic anhydrase inhibitors increases oxidative stress in the tear film.
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Affiliation(s)
- Lech Sedlak
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland.,Department of Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia in Katowice, Katowice, Poland
| | - Marta Świerczyńska
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland. .,Department of Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia in Katowice, Katowice, Poland.
| | - Weronika Borymska
- Department of Pharmacognosy and Phytochemistry, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Maria Zych
- Department of Pharmacognosy and Phytochemistry, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Dorota Wyględowska-Promieńska
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland.,Department of Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia in Katowice, Katowice, Poland
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Medication use and dry eye symptoms: A large, hypothesis-free, population-based study in the Netherlands. Ocul Surf 2021; 22:1-12. [PMID: 34171471 DOI: 10.1016/j.jtos.2021.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/13/2021] [Accepted: 06/16/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE To date, population-based studies reporting associations between dry eye disease and medications were hypothesis-driven, did not take into account underlying comorbidities, and did not investigate individual drugs. The purpose of this study was to clarify the association of dry eye symptoms with medication classes and individual drugs, using a hypothesis-free approach. METHODS 79,606 participants (age 20-97 years, 59.2% female) from the population-based Lifelines cohort in the Netherlands were cross-sectionally assessed for dry eye symptoms using the Womens' Health Study dry eye questionnaire. All medications used were coded with the ATC classification system. Logistic regression was used to assess the risk of the 59 most-used therapeutic/pharmacological subgroups and the 99 most-used individual drugs (all n > 200) on dry eye symptoms, correcting for age, sex, body mass index, and 48 comorbidities associated with dry eye. RESULTS Thirty-eight (64%) medication subgroups and fifty-two (53%) individual drugs were associated with dry eye symptoms (P < 0.05), after correction for age and sex only. A multivariable model correcting for comorbidities revealed highly significant associations between dry eye symptoms and drugs for peptic ulcer (particularly proton pump inhibitors (PPIs)), antiglaucoma and anticholinergic medications. CONCLUSIONS This study underlines that medication use is highly informative of risk of dry eye symptoms. Correction for underlying comorbidities is critical to avoid confounding effects. This study confirms suggested associations between medications and dry eye symptoms at a population level and shows several new associations. The novel link between PPIs and dry eye symptoms deserves particular attention given how commonly they are prescribed.
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Konstas AG, Labbé A, Katsanos A, Meier-Gibbons F, Irkec M, Boboridis KG, Holló G, García-Feijoo J, Dutton GN, Baudouin C. The treatment of glaucoma using topical preservative-free agents: an evaluation of safety and tolerability. Expert Opin Drug Saf 2021; 20:453-466. [PMID: 33478284 DOI: 10.1080/14740338.2021.1873947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Preservative-free (PF) medications represent a valuable treatment strategy in the lifelong management of glaucoma. By removing preservative toxicity, PF formulations provide tangible clinical benefits to glaucoma patients worldwide. They improve tolerability and adherence, leading to a positive impact in long-term intraocular pressure (IOP) control.Areas covered: A critical review of the subject is provided, including selected evidence on the safety and tolerability of currently available topical PF formulations. Cumulative evidence confirms that topical PF medications are at least equally efficacious to their preserved equivalents. There is convincing short-term evidence for superior tolerability and safety of PF formulations compared to preserved medications. The long-term benefits and success of PF therapy requires further elucidation.Expert opinion: Successful stepwise administration of medical therapy for glaucoma remains elusive. There is a greater risk for ocular toxicity and therapy failure with preserved topical glaucoma therapy. Currently available and emerging PF therapy options potentially optimize lifelong stepwise glaucoma therapy and may enhance outcome. To avert complications from preservatives leading to poor adherence, ideally, future antiglaucoma therapy should become 100% PF. There are still key aspects of PF therapy that warrant further investigation.
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Affiliation(s)
- Anastasios G Konstas
- 1st and 3rd University Departments of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antoine Labbé
- Department of Ophthalmology III, Quinze-Vingts Hospital, Paris, France;Quinze-Vingts Hospital, Paris, France; Inserm, ; RUPMC Univ Paris 06, Institut De La Vision; CNRS, ; CHNO Des Quinze-Vingts, INSERM-DHOS Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Andreas Katsanos
- Ophthalmology Department, University of Ioannina, Ioannina, Greece
| | | | - Murat Irkec
- Department of Ophthalmology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | | | - Gábor Holló
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Julián García-Feijoo
- Department of Ophthalmology, San Carlos Clinical Hospital, Health Research Institute (IdISSC), Universidad Complutense, Oftared, Madrid, Spain
| | - Gordon N Dutton
- Department of Optometry and Visual Science, Glasgow Caledonian University, Glasgow, UK
| | - Christophe Baudouin
- Department of Ophthalmology III, Quinze-Vingts Hospital, Paris, France;Quinze-Vingts Hospital, Paris, France; Inserm, ; RUPMC Univ Paris 06, Institut De La Vision; CNRS, ; CHNO Des Quinze-Vingts, INSERM-DHOS Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France
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Figus M, Agnifili L, Lanzini M, Brescia L, Sartini F, Mastropasqua L, Posarelli C. Topical preservative-free ophthalmic treatments: an unmet clinical need. Expert Opin Drug Deliv 2020; 18:655-672. [PMID: 33280452 DOI: 10.1080/17425247.2021.1860014] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: The main role of preservatives in eyedrops is to ensure sterility and microbiological integrity of the drug, and to facilitate the penetration of active compounds into the eye. However, several studies documented significant toxic effects induced by preservatives, especially on the ocular surface. Consequently, most of the ophthalmic medications became progressively available in preservative-free (PF) formulations.Areas covered: We analyzed pre-clinical and clinical studies on PF eyedrops with particular attention to common chronic diseases such as dry eye and glaucoma. We discussed about the pros and cons of using PF eyedrops, in terms of efficacy, safety, and social-economic aspects.Expert opinion: There are still unresolved issues that make hard for PF medications to definitively conquer the drug market. Despite robust pre-clinical evidences of less toxicity, the low number of randomized clinical trials does not permit to state that PF eyedrops have, in clinical practice, a similar efficacy or a higher safety compared to preserved forms. These aspects limit their use to chronic diseases requiring long-term therapies with multiple daily instillations, especially in the presence of concomitant ophthalmic diseases that expose to a risk of ocular surface worsening.
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Affiliation(s)
- Michele Figus
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Manuela Lanzini
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Lorenza Brescia
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Francesco Sartini
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Chiara Posarelli
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
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Baudouin C, Kolko M, Melik-Parsadaniantz S, Messmer EM. Inflammation in Glaucoma: From the back to the front of the eye, and beyond. Prog Retin Eye Res 2020; 83:100916. [PMID: 33075485 DOI: 10.1016/j.preteyeres.2020.100916] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 02/08/2023]
Abstract
The pathophysiology of glaucoma is complex, multifactorial and not completely understood. Elevated intraocular pressure (IOP) and/or impaired retinal blood flow may cause initial optic nerve damage. In addition, age-related oxidative stress in the retina concurrently with chronic mechanical and vascular stress is crucial for the initiation of retinal neurodegeneration. Oxidative stress is closely related to cell senescence, mitochondrial dysfunction, excitotoxicity, and neuroinflammation, which are involved in glaucoma progression. Accumulating evidence from animal glaucoma models and from human ocular samples suggests a dysfunction of the para-inflammation in the retinal ganglion cell layer and the optic nerve head. Moreover, quite similar mechanisms in the anterior chamber could explain the trabecular meshwork dysfunction and the elevated IOP in primary open-angle glaucoma. On the other hand, ocular surface disease due to topical interventions is the most prominent and visible consequence of inflammation in glaucoma, with a negative impact on filtering surgery failure, topical treatment efficacy, and possibly on inflammation in the anterior segment. Consequently, glaucoma appears as an outstanding eye disease where inflammatory changes may be present to various extents and consequences along the eye structure, from the ocular surface to the posterior segment, and the visual pathway. Here we reviewed the inflammatory processes in all ocular structures in glaucoma from the back to the front of the eye and beyond. Our approach was to explain how para-inflammation is necessary to maintain homoeostasis, and to describe abnormal inflammatory findings observed in glaucomatous patients or in animal glaucoma models, supporting the hypothesis of a dysregulation of the inflammatory balance toward a pro-inflammatory phenotype. Possible anti-inflammatory therapeutic approaches in glaucoma are also discussed.
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Affiliation(s)
- Christophe Baudouin
- Quinze-Vingts National Ophthalmology Hospital, INSERM-DGOS CIC 1423, IHU Foresight, Paris, France; Sorbonne Université, INSERM, CNRS, Institut de La Vision, Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, APHP, Université de Versailles Saint-Quentin en Yvelines, Boulogne-Billancourt, France.
| | - Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark; Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Glostrup, Denmark
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Kumar S, Singh T, Ichhpujani P, Vohra S, Thakur S. Correlation of Ocular Surface Disease and Quality of Life in Indian Glaucoma Patients: BAC-preserved versus BAC-free Travoprost. Turk J Ophthalmol 2020; 50:75-81. [PMID: 32366084 PMCID: PMC7204904 DOI: 10.4274/tjo.galenos.2019.29000] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 12/25/2019] [Indexed: 12/01/2022] Open
Abstract
Objectives The use of benzalkonium chloride (BAC)-preserved medications is associated with ocular surface disease (OSD) that can negatively affect quality of life (QoL) in glaucoma patients. This study aimed to compare QoL and correlate it with OSD in glaucoma patients receiving BAC-preserved and BAC-free travoprost. Materials and Methods A total of 110 subjects were divided into 3 groups: 40 primary open-angle glaucoma (POAG) patients using BAC-preserved travoprost, 40 POAG patients using BAC-free travoprost, and 30 age-matched controls. All patients were assessed using a single interviewer-administered format of the Ocular Surface Disease index (OSDI) and Glaucoma Quality of Life-15 (GQL-15) questionnaires. Results Mean GQL-15 score in the BAC group was significantly higher than in the BAC-free group (24.71±7.42 vs. 17.58±3.06; p<0.05). The mean difference in GQL-15 scores between controls and the BAC-free group (1.24) was insignificant (p>0.05). There was a strong positive correlation between OSDI scores and GQL-15 scores in all the groups (r values: BAC: 0.63, BAC-free: 0.23, controls: 0.29), with higher OSDI scores (severe OSD) associated with higher GQL-15 scores (worse QoL). Cronbach's alpha was 0.84 for GQL-15 and 0.75 for OSDI. Conclusion BAC-preserved travoprost leads to higher OSDI scores, which correlate strongly with poor QoL scores as compared to BAC-free travoprost. The use of BAC-free formulations should be encouraged to reduce the onset or worsening of OSD and impaired QoL in glaucoma patients.
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Affiliation(s)
- Suresh Kumar
- Government Medical College and Hospital, Department of Ophthalmology, Sector 32B, Chandigarh, India
| | - Tanu Singh
- Government Medical College and Hospital, Department of Ophthalmology, Sector 32B, Chandigarh, India
| | - Parul Ichhpujani
- Government Medical College and Hospital, Department of Ophthalmology, Sector 32B, Chandigarh, India
| | - Sanchi Vohra
- Government Medical College and Hospital, Department of Ophthalmology, Sector 32B, Chandigarh, India
| | - Sahil Thakur
- Government Medical College and Hospital, Department of Ophthalmology, Sector 32B, Chandigarh, India
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12
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Fogagnolo P, Torregrossa G, Tranchina L, Ferreras A, De Cillá S, Labbé A, Figus M, Ottobelli L, Rossetti L. Tear Film Osmolarity, Ocular Surface Disease and Glaucoma: A Review. Curr Med Chem 2019; 26:4241-4252. [PMID: 31345142 DOI: 10.2174/0929867326666190725160621] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/23/2018] [Accepted: 01/10/2019] [Indexed: 12/16/2022]
Abstract
Glaucoma is the second leading cause of blindness in the world, affecting more than 60 million people globally. In order to reduce the progression of the disease, both medical and surgical treatments are used. Frequent side effects of both treatments include a range of modifications of the ocular surface grouped as the Ocular Surface Disease (OSD), which include Dry Eye Disease (DED). DED and other OSD negatively impact on the success of anti-glaucoma treatments and reduce the adherence to medical therapies. Tear film osmolarity (TFO) is a relatively novel test which has become a hallmark of DED. The aim of this paper was to review the association between OSD, DED and glaucoma in view of published TFO data, and to discuss future fields of research and treatments on the topic of glaucoma iatrogenic damage.
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Affiliation(s)
- Paolo Fogagnolo
- Eye Clinic, San Paolo Hospital, University of Milan, Milan, Italy
| | | | - Laura Tranchina
- Eye Clinic, San Paolo Hospital, University of Milan, Milan, Italy
| | - Antonio Ferreras
- Department of Ophthalmology, Miguel Servet University Hospital, University of Zaragoza, Zaragoza, Spain
| | - Stefano De Cillá
- Unit of Ophthalmology, Ospedale Maggiore della Carita, Novara, Italy
| | - Antoine Labbé
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Vision Institute, Versailles Saint-Quentin en Yvelines University, 75012 Paris, France
| | - Michele Figus
- Ophthalmology, Department of Neurosciences, University of Pisa, Pisa, Italy
| | - Laura Ottobelli
- Eye Clinic, San Paolo Hospital, University of Milan, Milan, Italy
| | - Luca Rossetti
- Eye Clinic, San Paolo Hospital, University of Milan, Milan, Italy
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13
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Walsh K, Jones L. The use of preservatives in dry eye drops. Clin Ophthalmol 2019; 13:1409-1425. [PMID: 31447543 PMCID: PMC6682755 DOI: 10.2147/opth.s211611] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/03/2019] [Indexed: 12/14/2022] Open
Abstract
Topical ocular preparations are widely recommended by health care professionals, or chosen by patients, to help manage dry eye disease (DED). The chronic and progressive nature of DED may result in the administration of topical products several times a day, over a period of many years. Given DED is a condition that by definition affects the ocular surface, it is important to understand how the repeated use of eye drops may impact the ocular surface, influence clinical signs, affect symptoms, and impact the overall disease process of dry eye. The component in topical preparations with the greatest potential to adversely affect the ocular surface is the preservative. This paper reviews the literature in relation to the use of preservatives in formulations for dry eye. The ocular effects of benzalkonium chloride (BAK) are summarised and compared to the performance of alternative preservatives and preservative-free formulations. Use of preserved and preservative-free drops in relation to the management of varying stages of DED is discussed.
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Affiliation(s)
- Karen Walsh
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, N2L 3G1, Canada
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, N2L 3G1, Canada
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14
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Timolol 0.1% in Glaucomatous Patients: Efficacy, Tolerance, and Quality of Life. J Ophthalmol 2019; 2019:4146124. [PMID: 31191995 PMCID: PMC6525866 DOI: 10.1155/2019/4146124] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 02/24/2019] [Indexed: 01/30/2023] Open
Abstract
Glaucoma is a progressive, chronic optic neuropathy characterized by a typical visual field defects. Four main classes of topical medication are actually available on the market: beta-blockers, prostaglandins, alpha2-agonists, and topical carbonic anhydrase inhibitor to treat intraocular pressure (IOP). The aim of this review is to outline the efficacy of timolol and to evaluate the impact of this treatment on patients' quality of life. Among beta-blockers, timolol is most used at three different concentrations: 0.1%, 0.25%, and 0.5%. While the first one is a gel, the other two products are solution. Timolol has few topical side effects, while it has some important systemic side effects on the cardiac and respiratory systems. The balance between efficacy and safety is always the main aspect to care patients. Because of the less efficacy of timolol 0.1% solution, the possibility to use carbomers as vehicle in the gel drops helped timolol 0.1 to be used in clinics, extending the time contact between the active ingredient and the surface of the cornea. Using preservative-free timolol 0.1 for treatment, IOP was at the same level of the other beta-blockers at higher concentration, but it was better tolerated. Preservative-free treatment improved the quality of life reducing dry-eye like symptoms; furthermore, the presence of an artificial tear in the medication bottle could help adherence. The once daily dosing improves compliance.
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15
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Hovanesian J, Holland E. Tolerability and toxicity of topically applied nepafenac 0.3% compared with generic ketorolac 0.5%. J Cataract Refract Surg 2019; 45:174-180. [DOI: 10.1016/j.jcrs.2018.08.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/16/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022]
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16
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Lazreg S, Merad Z, Nouri MT, Garout R, Derdour A, Ghroud N, Kherroubi R, Meziane M, Belkacem S, Ouhadj O, Baudouin C, Tiar M. Efficacy and safety of preservative-free timolol 0.1% gel in open-angle glaucoma and ocular hypertension in treatment-naïve patients and patients intolerant to other hypotensive medications. J Fr Ophtalmol 2018; 41:945-954. [PMID: 30477719 DOI: 10.1016/j.jfo.2018.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/20/2018] [Indexed: 11/26/2022]
Abstract
GOALS To assess the efficacy and safety of preservative-free timolol 0.1% gel in patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT). METHODS In this multicenter, open-label, non-controlled clinical trial in Algeria, treatment-naïve patients with intraocular pressure (IOP)>20mmHg and<31mmHg (treatment-naïve patients, group 1) and patients with IOP controlled by current ocular monotherapy but presenting with local intolerance in at least one eye (intolerant patients; group 2) were eligible. Timolol gel was administered once daily in the morning for 84 days. The primary efficacy criteria were reduction in IOP (group 1) and maintenance of baseline IOP (group 2). RESULTS Overall, 93 patients were included (53 in group 1, 40 in group 2). All patients in group 2 had been previously treated with preserved eye drops. In group 1, patients showed a significant reduction in IOP with mean changes in the worse eye of -10.3±3.0mmHg at D28 and -10.8±2.5mmHg at D84 (P<0.0001). In group 2, the maintenance of efficacy on IOP at D84 was satisfactory in 91.7% of patients (worse eye). Preservative-free timolol gel was well tolerated in both groups. In group 2, the overall symptom score was significantly reduced from 8.6±5.1 to 0.9±1.6 at D28 and 0.7±1.2 at D84 (P<0.0001), and the overall ocular sign score from 3.7±2.1 to 0.8±1.0 at D28 and 0.6±0.8 at D84 (P<0.0001). CONCLUSIONS This preservative-free timolol 0.1% gel was effective in decreasing IOP in treatment-naïve patients and in controlling IOP and reducing ocular signs and symptoms in patients intolerant to their previous preserved medications.
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Affiliation(s)
- S Lazreg
- Private practice, Ophthalmology, Blida, Algeria
| | - Z Merad
- CHU, Ophthalmology, Blida, Algeria
| | - M T Nouri
- CHU Benimessous, Ophthalmology, Algiers, Algeria
| | - R Garout
- HCA, Ophthalmology, Algiers, Algeria
| | | | - N Ghroud
- Military Hospital, Ophthalmology, Oran, Algeria
| | - R Kherroubi
- CHU Mustapha, Ophthalmology, Algiers, Algeria
| | - M Meziane
- Private practice, Ophthalmology, Oran, Algeria
| | | | - O Ouhadj
- CHU Mustapha, Ophthalmology, Algiers, Algeria
| | - C Baudouin
- Ophthalmology, XV-XX Hospital, 16008 Paris, France
| | - M Tiar
- CHU Lamine Debbaghine, Bab El Oued, Ophtalmologie, Alger, Algeria.
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17
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Holló G, Katsanos A, Boboridis KG, Irkec M, Konstas AGP. Preservative-Free Prostaglandin Analogs and Prostaglandin/Timolol Fixed Combinations in the Treatment of Glaucoma: Efficacy, Safety and Potential Advantages. Drugs 2018; 78:39-64. [PMID: 29196953 DOI: 10.1007/s40265-017-0843-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Glaucoma therapy-related ocular surface disease (OSD) is a serious pathology with a broad spectrum of insidious clinical presentations and complex pathogenesis that undermines long-term glaucoma care. Preservatives, especially benzalkonium chloride (BAK), contained in topical intraocular pressure-lowering medications frequently cause or aggravate OSD in glaucoma. Management of these patients is challenging, and to date often empirical due to the scarcity of controlled long-term clinical trials. Most of the available data are extracted from case series and retrospective analysis. Preservative-free prostaglandins and prostaglandin/timolol fixed combinations are novel options developed to remove the harmful impact of preservatives, especially BAK, upon ocular tissues. Based on what is currently known on the value of preservative-free antiglaucoma therapies it is tempting to speculate how these new therapies may affect the future medical management of all glaucoma patients. This article provides a comprehensive and critical review of the current literature on preservative-free prostaglandins and preservative-free prostaglandin/timolol fixed combinations.
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Affiliation(s)
- Gábor Holló
- Department of Ophthalmology, Semmelweis University, Maria u. 39, Budapest, 1085, Hungary.
| | - Andreas Katsanos
- Ophthalmology Department, University of Ioannina, Ioannina, Greece
| | - Kostas G Boboridis
- Third Ophthalmology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Murat Irkec
- Department of Ophthalmology, Faculty of Ophthalmology, Hacettepe University, Ankara, Turkey
| | - Anastasios G P Konstas
- 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece.,3rd University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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18
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Misiuk-Hojlo M, Pomorska M, Mulak M, Rekas M, Wierzbowska J, Prost M, Wasyluk J, Lubinski W, Podboraczynska-Jodko K, Romaniuk W, Kinasz R, Ortyl-Markiewicz R, Mocko L, Zaleska-Zmijewska A, Rokicki D, Baudouin C. The RELIEF study: Tolerability and efficacy of preservative-free latanoprost in the treatment of glaucoma or ocular hypertension. Eur J Ophthalmol 2018; 29:210-215. [PMID: 29998767 PMCID: PMC6431781 DOI: 10.1177/1120672118785280] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: To assess tolerability and efficacy following a switch from benzalkonium chloride–latanoprost to preservative-free latanoprost in patients with glaucoma or ocular hypertension. Methods: A total of 140 patients with glaucoma or ocular hypertension controlled with benzalkonium chloride-latanoprost for at least 3 months were switched to treatment with preservative-free latanoprost. Assessments were made on days 15, 45, and 90 (D15, D45, and D90) and included best-corrected visual acuity, intraocular pressure, slit lamp examination, fluorescein staining, tear film break-up time, patient symptom evaluation, and subjective estimation of tolerability. Results: Mean best-corrected visual acuity remained unchanged during the study. Mean intraocular pressure compared with baseline (D0) remained stable throughout the study (D0, 15.9 mmHg (standard deviation = 2.6); D90, 15.3 mmHg (standard deviation = 2.4); p < 0.006). Tear film break-up time improved or remained unchanged relative to baseline in 92% of patients at D45 and in 93% at D90. Moderate-to-severe conjunctival hyperemia was seen in 56.8% of patients at D0, but this figure decreased to 13.7%, 2.2%, and 1.6% at D15, D45, and D90, respectively. Subjective assessment of tolerability (0–10 scale) indicated improvement with change of therapy (mean score: 5.3 (standard deviation = 2.2) at D0 versus 1.9 (standard deviation = 1.7) at D90; p < 0.0001). Conclusion: Preservative-free latanoprost has at least the same intraocular pressure-lowering efficacy as benzalkonium chloride–latanoprost, with a better tolerability profile. This may translate into greater control of treatment and improved quality of life.
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Affiliation(s)
- Marta Misiuk-Hojlo
- 1 Department of Ophthalmology, Wroclaw Medical University, Wroclaw, Poland
| | - Maria Pomorska
- 1 Department of Ophthalmology, Wroclaw Medical University, Wroclaw, Poland
| | - Malgorzata Mulak
- 1 Department of Ophthalmology, Wroclaw Medical University, Wroclaw, Poland
| | - Marek Rekas
- 2 Department of Ophthalmology, Military Institute of Medicine, Warsaw, Poland
| | - Joanna Wierzbowska
- 2 Department of Ophthalmology, Military Institute of Medicine, Warsaw, Poland
| | - Marek Prost
- 3 Department of Ophthalmology, Military Institute of Aviation Medicine, Warsaw, Poland
| | - Jaromir Wasyluk
- 3 Department of Ophthalmology, Military Institute of Aviation Medicine, Warsaw, Poland
| | - Wojciech Lubinski
- 4 Department of Ophthalmology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | - Wanda Romaniuk
- 5 Department of Ophthalmology, Medical University of Silesia, Katowice, Poland
| | - Renata Kinasz
- 5 Department of Ophthalmology, Medical University of Silesia, Katowice, Poland
| | | | - Lucyna Mocko
- 7 Ophthalmology Outpatient Clinic, ZWPS in Katowice, Katowice, Poland
| | - Anna Zaleska-Zmijewska
- 8 Department of Ophthalmology, SPKSO Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Dariusz Rokicki
- 8 Department of Ophthalmology, SPKSO Hospital, Medical University of Warsaw, Warsaw, Poland
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19
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Abstract
Preservatives used in topical glaucoma medications have a plethora of well-described toxic effects on the ocular surface. Such ocular toxicity is manifest clinically as ocular surface disease (OSD) and has been confirmed in epidemiologic, prospective clinical trials and studies in which patients are switched from preservative-added to preservative-free topical therapy. Such toxicity has implications not only for tolerability, but also for adherence and persistence with therapy that is known to be poor in glaucoma. Glaucoma medication is now widely available in preservative-free formulations, and the question arises as to which patients should receive preservative-free glaucoma therapy in preference to preservative-added medication. A case can be made for several subpopulations of patients who might particularly benefit from preservative-free medication: patients with existing OSD, older patients, younger adult patients, female patients, pediatric and juvenile patients, patients who work in air-conditioned environments or who use electronic screens frequently, patients with medical risk factors for OSD, patients in whom trabecular surgery may become indicated in the future, contact lens users, perhaps patients with Asian ethnicity and patients with severe or treatment-refractory glaucoma. Whilst arguments could be made for selecting patients for preservative-free medication on the basis of their existing risk of OSD, collectively, these patients form a significant proportion of the glaucoma patient population as a whole and, in the absence of any cost premium or positive indication for preservative-added medication, preservative-free glaucoma medication for all patients seems an appropriate strategy.
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Affiliation(s)
- John Thygesen
- Department of Ophthalmology, Glaucoma Services in Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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20
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Rolle T, Spinetta R, Nuzzi R. Long term safety and tolerability of Tafluprost 0.0015% vs Timolol 0.1% preservative-free in ocular hypertensive and in primary open-angle glaucoma patients: a cross sectional study. BMC Ophthalmol 2017; 17:136. [PMID: 28768500 PMCID: PMC5541512 DOI: 10.1186/s12886-017-0534-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 07/25/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The effects of preservatives of antiglaucoma medications on corneal surface and tear function have been widely shown in literature; it's not the same as regards the active compounds themselves. The purpose of our study was to compare Ocular Surface Disease (OSD) signs and symptoms of Tafluprost 0.0015% versus preservative free (PF) Timolol 0.1% eyedrops in ocular hypertensive (OH) and in primary open-angle glaucoma (POAG) patients. METHODS A cross-sectional study included patients in monotherapy for at least 36 months with Tafluprost 0.0015% (27) or PF Timolol 0.1% (24) and 20 healthy age and sex-matched volunteers. All subjects underwent clinical tests (Schirmer I and break-up time), in vivo confocal microscopy (IVCM) and were surveyed using Ocular Surface Disease Index (OSDI) and Glaucoma Symptoms Scale (GSS) questionnaires. The groups were compared with ANOVA, Kruskal-Wallis test, t-test, Mann-Whitney test and Bonferroni's adjustment of p-values. RESULTS No significant differences were found in questionnaires scores, clinical tests, IVCM variables between therapy groups. Tafluprost 0.0015% group showed significantly higher OSDI score, basal epithelial cells density, stromal reflectivity, sub-basal nerves tortuosity (p = 0.0000, 0.037, 0.006, 0.0000) and less GSS score, number of sub-basal nerves (p = 0.0000, 0.037) than controls but similar clinical tests results (p > 0.05). PF Timolol group had significantly higher OSDI score, basal epithelial cells density, stromal reflectivity and sub-basal nerve tortuosity (p = 0.000, 0.014, 0.008, 0.002), less GSS score, BUT and number of sub-basal nerves (p = 0.0000, 0.026, 0.003) than controls. CONCLUSIONS Compared to PF Timolol 0.1%, Tafluprost 0.0015% showed similar safety with regards to tear function and corneal status and a similar tolerability profile. Both therapy groups show some alterations in corneal microstructure but no side effects on tear function except for an increased tear instability in PF Timolol 0.1% group. Ophtalmologists should be aware that even PF formulations may lead to a mild ocular surface impairment.
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Affiliation(s)
- Teresa Rolle
- Eye Clinic, Department of Surgical Sciences, University of Torino, Via Juvarra 19, 10122 Torino, Italy
| | - Roberta Spinetta
- Eye Clinic, Department of Surgical Sciences, University of Torino, Via Juvarra 19, 10122 Torino, Italy
| | - Raffaele Nuzzi
- Eye Clinic, Department of Surgical Sciences, University of Torino, Via Juvarra 19, 10122 Torino, Italy
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21
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Gomes JAP, Azar DT, Baudouin C, Efron N, Hirayama M, Horwath-Winter J, Kim T, Mehta JS, Messmer EM, Pepose JS, Sangwan VS, Weiner AL, Wilson SE, Wolffsohn JS. TFOS DEWS II iatrogenic report. Ocul Surf 2017; 15:511-538. [PMID: 28736341 DOI: 10.1016/j.jtos.2017.05.004] [Citation(s) in RCA: 255] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/02/2017] [Indexed: 01/04/2023]
Abstract
Dry eye can be caused by a variety of iatrogenic interventions. The increasing number of patients looking for eye care or cosmetic procedures involving the eyes, together with a better understanding of the pathophysiological mechanisms of dry eye disease (DED), have led to the need for a specific report about iatrogenic dry eye within the TFOS DEWS II. Topical medications can cause DED due to their allergic, toxic and immuno-inflammatory effects on the ocular surface. Preservatives, such as benzalkonium chloride, may further aggravate DED. A variety of systemic drugs can also induce DED secondary to multiple mechanisms. Moreover, the use of contact lens induces or is associated with DED. However, one of the most emblematic situations is DED caused by surgical procedures such as corneal refractive surgery as in laser-assisted in situ keratomileusis (LASIK) and keratoplasty due to mechanisms intrinsic to the procedure (i.e. corneal nerve cutting) or even by the use of postoperative topical drugs. Cataract surgery, lid surgeries, botulinum toxin application and cosmetic procedures are also considered risk factors to iatrogenic DED, which can cause patient dissatisfaction, visual disturbance and poor surgical outcomes. This report also presents future directions to address iatrogenic DED, including the need for more in-depth epidemiological studies about the risk factors, development of less toxic medications and preservatives, as well as new techniques for less invasive eye surgeries. Novel research into detection of early dry eye prior to surgeries, efforts to establish appropriate therapeutics and a greater attempt to regulate and oversee medications, preservatives and procedures should be considered.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), São Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | | | - Nathan Efron
- School of Optometry and Vision Science, Queensland University of Technology, Queensland, Australia
| | - Masatoshi Hirayama
- Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan
| | | | - Terry Kim
- Duke University School of Medicine, Durham, NC, USA; Duke University Eye Center, Durham, NC, USA
| | | | - Elisabeth M Messmer
- Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jay S Pepose
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Steven E Wilson
- Cole Eye Institute, The Cleveland Clinic, Cleveland, OH, USA
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22
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Jones L, Downie LE, Korb D, Benitez-del-Castillo JM, Dana R, Deng SX, Dong PN, Geerling G, Hida RY, Liu Y, Seo KY, Tauber J, Wakamatsu TH, Xu J, Wolffsohn JS, Craig JP. TFOS DEWS II Management and Therapy Report. Ocul Surf 2017; 15:575-628. [DOI: 10.1016/j.jtos.2017.05.006] [Citation(s) in RCA: 578] [Impact Index Per Article: 82.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 02/06/2023]
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23
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Denis P. Apport clinique du latanoprost sans conservateur dans le traitement du glaucome à angle ouvert et de l’hypertension oculaire. Étude multicentrique randomisée contrôlée. J Fr Ophtalmol 2016; 39:622-30. [DOI: 10.1016/j.jfo.2016.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/18/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
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24
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Liu S, Dozois MD, Chang CN, Ahmad A, Ng DLT, Hileeto D, Liang H, Reyad MM, Boyd S, Jones LW, Gu FX. Prolonged Ocular Retention of Mucoadhesive Nanoparticle Eye Drop Formulation Enables Treatment of Eye Diseases Using Significantly Reduced Dosage. Mol Pharm 2016; 13:2897-905. [PMID: 27482595 DOI: 10.1021/acs.molpharmaceut.6b00445] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Eye diseases, such as dry eye syndrome, are commonly treated with eye drop formulations. However, eye drop formulations require frequent dosing with high drug concentrations due to poor ocular surface retention, which leads to poor patient compliance and high risks of side effects. We developed a mucoadhesive nanoparticle eye drop delivery platform to prolong the ocular retention of topical drugs, thus enabling treatment of eye diseases using reduced dosage. Using fluorescent imaging on rabbit eyes, we showed ocular retention of the fluorescent dye delivered through these nanoparticles beyond 24 h while free dyes were mostly cleared from the ocular surface within 3 h after administration. Utilizing the prolonged retention of the nanoparticles, we demonstrated effective treatment of experimentally induced dry eye in mice by delivering cyclosporin A (CsA) bound to this delivery system. The once a week dosing of 0.005 to 0.01% CsA in NP eye drop formulation demonstrated both the elimination of the inflammation signs and the recovery of ocular surface goblet cells after a month. Thrice daily administration of RESTASIS on mice only showed elimination without recovering the ocular surface goblet cells. The mucoadhesive nanoparticle eye drop platform demonstrated prolonged ocular surface retention and effective treatment of dry eye conditions with up to 50- to 100-fold reduction in overall dosage of CsA compared to RESTASIS, which may significantly reduce side effects and, by extending the interdosing interval, improve patient compliance.
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Affiliation(s)
- Shengyan Liu
- Department of Chemical Engineering, University of Waterloo , Waterloo, Canada.,Waterloo Institute of Nanotechnology, University of Waterloo , Waterloo, Canada
| | - Matthew D Dozois
- Department of Chemical Engineering, University of Waterloo , Waterloo, Canada.,Waterloo Institute of Nanotechnology, University of Waterloo , Waterloo, Canada
| | - Chu Ning Chang
- Department of Chemical Engineering, University of Waterloo , Waterloo, Canada.,Waterloo Institute of Nanotechnology, University of Waterloo , Waterloo, Canada
| | - Aaminah Ahmad
- Department of Chemical Engineering, University of Waterloo , Waterloo, Canada.,Waterloo Institute of Nanotechnology, University of Waterloo , Waterloo, Canada
| | - Deborah L T Ng
- Department of Chemical Engineering, University of Waterloo , Waterloo, Canada.,Waterloo Institute of Nanotechnology, University of Waterloo , Waterloo, Canada
| | - Denise Hileeto
- Centre for Contact Lens Research, School of Optometry and Vision Science, University of Waterloo , Waterloo, Canada
| | - Huiyuan Liang
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital , Toronto, Canada
| | - Matthew-Mina Reyad
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital , Toronto, Canada
| | - Shelley Boyd
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital , Toronto, Canada
| | - Lyndon W Jones
- Waterloo Institute of Nanotechnology, University of Waterloo , Waterloo, Canada.,Centre for Contact Lens Research, School of Optometry and Vision Science, University of Waterloo , Waterloo, Canada
| | - Frank X Gu
- Department of Chemical Engineering, University of Waterloo , Waterloo, Canada.,Waterloo Institute of Nanotechnology, University of Waterloo , Waterloo, Canada
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25
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Aguayo Bonniard A, Yeung JY, Chan CC, Birt CM. Ocular surface toxicity from glaucoma topical medications and associated preservatives such as benzalkonium chloride (BAK). Expert Opin Drug Metab Toxicol 2016; 12:1279-1289. [PMID: 27398637 DOI: 10.1080/17425255.2016.1209481] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This review discusses the evidence concerning the effect of topical medications and their preservatives on the ocular surface in glaucoma patients. The role of topical anti-glaucoma medication remains critical in the management of chronic glaucoma worldwide but the beneficial effects of treatment are counterbalanced by the adverse effects of corneal and conjunctival toxicity. Areas covered: This article covers the effect of topical ocular drops and preservatives, particularly benzalkonium chloride, on the cornea and conjunctiva. Both basic science and clinical evidence will be presented. The first part reviews the relationship between ocular surface disease and benzalkonium chloride and the evidence from non-benzalkonium chloride preserved drops. The second part discusses the effects of benzalkonium chloride on the histopathology of the conjunctiva and its impact on clinical care as well as quality of life. Expert opinion: Topical anti-glaucoma medication will continue to be used in the management of this blinding disease for the foreseeable future. Treatment outcomes will benefit from minimized exposure to benzalkonium chloride. The development of alternative preservatives, preservative-free topical options, and non-drop therapeutics such as drug-eluting systems for the delivery of ocular medications, will be very helpful in the care of glaucoma patients.
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Affiliation(s)
- Alberto Aguayo Bonniard
- a Department of Ophthalmology and Vision Sciences , University of Toronto , Toronto , Canada
| | - Jacky Y Yeung
- a Department of Ophthalmology and Vision Sciences , University of Toronto , Toronto , Canada.,b Department of Ophthalmology , Queen's University , Kingston , Ontario
| | - Clara C Chan
- a Department of Ophthalmology and Vision Sciences , University of Toronto , Toronto , Canada
| | - Catherine M Birt
- a Department of Ophthalmology and Vision Sciences , University of Toronto , Toronto , Canada
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Advances in Confocal Microscopy of the Eye. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1794240. [PMID: 27298821 PMCID: PMC4889803 DOI: 10.1155/2016/1794240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 11/17/2022]
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Abstract
Childhood glaucoma is a major therapeutic challenge for pediatric ophthalmologists and glaucoma specialists worldwide. Management depends on the etiology and age at presentation. A variety of drugs are available for the control of intraocular pressure in children; however, none of these drugs have been licensed by the regulatory agencies for use in children. Furthermore, evidence gained from randomized controlled trials in the pediatric population is sparse, and little is known regarding the use of newer anti-glaucoma preparations. This evidence-based review aims to discuss the available pharmacotherapeutic options for glaucoma in children. Topical adrenoceptor blockers, topical and systemic carbonic anhydrase inhibitors, prostaglandin (PG) analogs, adrenoceptor agonists, parasympathomimetics, and combined preparations are available for use in children, but usually as an off-label indication. Therefore, it is important to recognize that serious side effects have been reported, even with topical drops, and measures to reduce systemic absorption should be taken. Most drugs have been shown to have comparable ocular hypotensive effects, with the lowest occurrence of systemic side effects with PG analogs. Whereas a newly introduced prostaglandin analog, tafluprost, and some other preservative-free preparations have shown promising results in adult glaucoma patients, no pediatric reports are available as yet. Future studies may describe their role in treating pediatric glaucoma. This review also shares some suggested treatment pathways for primary congenital glaucoma (PCG), juvenile open angle glaucoma (JOAG), developmental glaucoma, aphakic/pseudophakic glaucoma, and uveitic glaucoma.
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Affiliation(s)
- Monica Samant
- Children's Hospital of Pittsburgh of UPMC, Pediatric Ophthalmology, Strabismus, and Adult Motility, 4401 Penn Avenue, Suite 5000, Pittsburgh, PA, 15224, USA.,UPMC Eye Center, Pittsburgh, USA
| | - Anagha Medsinge
- Children's Hospital of Pittsburgh of UPMC, Pediatric Ophthalmology, Strabismus, and Adult Motility, 4401 Penn Avenue, Suite 5000, Pittsburgh, PA, 15224, USA.,UPMC Eye Center, Pittsburgh, USA.,University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Ken K Nischal
- Children's Hospital of Pittsburgh of UPMC, Pediatric Ophthalmology, Strabismus, and Adult Motility, 4401 Penn Avenue, Suite 5000, Pittsburgh, PA, 15224, USA. .,UPMC Eye Center, Pittsburgh, USA. .,University of Pittsburgh School of Medicine, Pittsburgh, USA.
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Barsotti G, Vezzosi T. Keratoconjunctivitis sicca exacerbation in a dog treated with systemic atenolol. J Small Anim Pract 2016; 57:379-81. [DOI: 10.1111/jsap.12477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 11/03/2015] [Accepted: 01/14/2016] [Indexed: 11/26/2022]
Affiliation(s)
- G. Barsotti
- Department of Veterinary Sciences; University of Pisa; Via Livornese (lato monte) 56122 San Piero a Grado Pisa Italy
| | - T. Vezzosi
- Department of Veterinary Sciences; University of Pisa; Via Livornese (lato monte) 56122 San Piero a Grado Pisa Italy
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Vagge A, Bonino M, Rolando M, Macrì A, Traverso CE, Iester M. The utility of an artificial substitute to improve corneal sensitivity in glaucomatous patients on chronic therapy with prostaglandin analogs. J Ocul Pharmacol Ther 2015; 31:286-90. [PMID: 25974240 DOI: 10.1089/jop.2014.0131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate whether a tear substitute can improve corneal subepithelial nerve plexus and corneal sensitivity in glaucomatous patients. METHODS This study was prospective, longitudinal, and single arm. Twenty glaucomatous patients were recruited. All the patients were treated with a prostaglandin analog with preservative for at least 1 year. Preservative-free artificial tears (0.5% tamarind seed polysaccharide 0.5(®) eye drops single-dose preservative free [Oftagen]) were prescribed thrice per day. The participants were subjected to clinical and instrumental evaluation at baseline (T0), after 1 month (T1) and after 3 months (T3) of treatment. All patients were examined with a digital corneal confocal laser-scanning microscope (HRT II Rostock Cornea Module; Heidelberg Engineering GmbH) and Cochet-Bonnet corneal esthesiometer. RESULTS After the artificial substitute, corneal and conjunctival sensitivity significantly (P < 0.001) improved at T1 and T3 compared to the baseline. A significant correlation was found between break-up time and both central corneal sensitivity and the number of fibers. CONCLUSION The use of a preservative-free artificial substitute in association with a topical therapy with chronic preservative could increase the compliance of patients.
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Affiliation(s)
- Aldo Vagge
- 1Clinica Oculistica, DiNOGMI, University of Genoa, Genoa, Italy
| | - Michele Bonino
- 1Clinica Oculistica, DiNOGMI, University of Genoa, Genoa, Italy
| | | | - Angelo Macrì
- 2Azienda Ospedaliera Universitaria San Martino IST, Genova, Italy
| | | | - Michele Iester
- 1Clinica Oculistica, DiNOGMI, University of Genoa, Genoa, Italy
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Topical cyclosporine to control ocular surface disease in patients with chronic glaucoma after long-term usage of topical ocular hypotensive medications. Eye (Lond) 2015; 29:808-14. [PMID: 25857609 DOI: 10.1038/eye.2015.40] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 02/08/2015] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To evaluate changes in ocular surface and central corneal sub-basal nerve fiber layer (SBNFL) after topical cyclosporin therapy in chronic glaucoma patients on long-term topical antiglaucoma therapy. METHODS A prospective comparative study of ocular surface evaluation of chronic glaucoma patients on long-term topical therapy treated concurrently with a topical cyclosporine 0.05% twice daily for 6 months and controls was done. The study parameters evaluated at recruitment and at the 6-month follow-up included details of topical antiglaucoma medications, visual acuity, intraocular pressure, ocular surface evaluation parameters (TBUT, Schirmers I, ocular surface staining scores and ocular surface disease (OSD) index score (OSDI)), central corneal sensation (Cochet Bonnett aesthesiometer), and central confocal microscopy to study the SBNFL density (SBNFLD). RESULTS Thirty-two eyes of 16 patients with chronic glaucoma and 30 eyes of 15 normal subjects as controls were studied. Mean TBUT, pre/post CsA treatment was 8.67±3.01/12.24±1.83 s (P=0.007). Mean conjunctival/corneal staining scores pre/post CsA treatment were 3.38±1.93/1.50±0.718 (P=0.00) /5.19±1.82/1.81±0.78 (P=0.098), respectively. Mean OSDI pre/post CsA treatment scores were 30.63±14.61/14.76±6.06 (P=0.007). Mean corneal sensations scores pre/post CsA treatment were 4.64±0.46/4.94±0.39 (P=0.002). Central corneal SBNFLD pre and post CsA treatment was 8811.35±2985.29/10335.13±4092.064 μm/mm(2) (P=0.0001). CONCLUSIONS Schirmer's test, ocular surface staining scores, OSDI, corneal sensations, and corneal SBNFLD showed a statistically significant improvement following a 6-month concurrent topical CsA therapy.
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A 1-year randomized study of the clinical and confocal effects of tafluprost and latanoprost in newly diagnosed glaucoma patients. Adv Ther 2015; 32:356-69. [PMID: 25893514 PMCID: PMC4415941 DOI: 10.1007/s12325-015-0205-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Indexed: 11/28/2022]
Abstract
Introduction The aim of the present study was to compare the confocal and clinical features of newly diagnosed glaucoma patients receiving unpreserved prostaglandins (tafluprost) versus preserved prostaglandins (latanoprost). Materials and Methods 40 patients were randomized to tafluprost 0.0015% (20 patients; 32 eyes) or latanoprost 0.005% + benzalkonium chloride 0.02% (20 patients; 35 eyes) once daily for 1 year. Inclusion criteria were new glaucoma diagnosis, and no ocular treatments for 6 months before the study. Patients were evaluated at baseline and every 3 months with a complete ophthalmologic evaluation, Schirmer’s test, break-up time test, confocal microscopy of the central cornea, and measurement of intraocular pressure (IOP). Investigators were masked to treatment. Both eyes were analyzed if they fulfilled inclusion criteria. Treatments and changes between follow-up and baseline were compared by analysis of variance (ANOVA), t test and Chi-square test. Results At baseline, the two groups had similar age, ocular surface and confocal findings; keratocyte activation was present in 40%, branching pattern in 85%, and beading in 75%, with no inter-group differences. At follow-up, no significant clinical changes were detected, apart from a drop of IOP by 3.6–4.2 mmHg in the two groups (p < 0.001, with no difference between treatments). Despite inter-treatment ANOVA for confocal microscopy being negative, subtle changes were present. During follow-up, all eyes without nerve branching pattern at baseline progressively developed it when treated with latanoprost, whereas no change occurred using tafluprost treatment (p = 0.05). None of the eyes without beading at baseline developed it at the end of the study in the tafluprost group, whereas beading did occur in 75% of patients treated with latanoprost (p = 0.05). Both treatments were associated with increased keratocyte activation at follow-up; the change from baseline was statistically significant after month 3 with latanoprost (p = 0.02) and after month 6 with tafluprost (p = 0.04). Conclusions The two study treatments had similar clinical effects, but tafluprost had a more favorable profile for some confocal parameters of the cornea. Funding Merck Sharp & Dohme International. Electronic supplementary material The online version of this article (doi:10.1007/s12325-015-0205-5) contains supplementary material, which is available to authorized users.
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Shimizu Y, Nakakura S, Nishiyama M, Tabuchi H, Kiuchi Y. Efficiency, safety, and patient preference of switching from dorzolamide 1%/timolol 0.5% to brinzolamide 1%/timolol 0.5% while maintaining the prostaglandin F2α analog. Clin Ophthalmol 2015; 9:475-82. [PMID: 25792800 PMCID: PMC4362984 DOI: 10.2147/opth.s79680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background We investigated the efficiency, safety and patient preference of switching from dorzolamide 1%/timolol 0.5% to brinzolamide 1%/timolol 0.5% while maintaining the prostaglandin F2α analog. Methods We initially enrolled 44 eyes from 44 primary open angle glaucoma patients, and a total of 42 patients completed the study. All patients were under treatment with various prostaglandin F2α analogs and dorzolamide 1%/timolol 0.5%. While maintaining the prostaglandin F2α analog, dorzolamide 1%/timolol 0.5% was switched to brinzolamide 1%/timolol 0.5%. Conjunctival hyperemia, superficial punctate keratopathy, and intraocular pressure (IOP) were evaluated at baseline and at 4, 12, and 24 weeks. Adverse events and patient preferences, measured using a questionnaire at study initiation and at 24 weeks, were also noted. Results The IOP was 17.7±1.7, 16.8±2.6, 16.7±2.2, and 16.7±2.4 mmHg at baseline and at 4, 12, and 24 weeks, respectively, with no significant differences in IOP values at any time point (P=0.117, one-way analysis of variance). In addition, no significant differences were found in the incidence of conjunctival hyperemia or SPK score at any time point (all P>0.5, by Kruskal–Wallis test). Based on the evaluation of side effects using the questionnaire, stinging/burning was less common (P=0.042), while blurred vision was more common (P=0.003), after switching to brinzolamide 1%/timolol 0.5%. Regarding patient preferences, 13 patients (31%) preferred dorzolamide 1%/timolol 0.5%, 12 patients (29%) preferred brinzolamide 1%/timolol 0.5%, and 17 patients (40%) preferred neither. Conclusion When switching from dorzolamide 1%/timolol 0.5% to brinzolamide 1%/timolol 0.5%, the IOP values and incidence of superficial punctate keratopathy and conjunctival hyperemia were sustained throughout the 24-week observation period, and the patient preferences were similar for the two regimens. However, differences were observed in the ocular sensations of stinging/burning with dorzolamide 1%/timolol 0.5% and blurred vision with brinzolamide 1%/timolol 0.5%.
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Affiliation(s)
- Yoshie Shimizu
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
| | - Shunsuke Nakakura
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
| | - Makiko Nishiyama
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
| | - Hitoshi Tabuchi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Holló G, Katsanos A. Safety and tolerability of the tafluprost/timolol fixed combination for the treatment of glaucoma. Expert Opin Drug Saf 2015; 14:609-17. [DOI: 10.1517/14740338.2015.1010507] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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