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Chauchat L, Guerin C, Rebika H, Sahyoun M, Collignon N. Real-Life Study on the Efficacy and Tolerance of a Preservative-Free Surfactant-Free Latanoprost Eye Drop in Patients with Glaucoma. Ophthalmol Ther 2024; 13:2661-2677. [PMID: 39133376 PMCID: PMC11408444 DOI: 10.1007/s40123-024-01013-x] [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: 06/26/2024] [Accepted: 07/25/2024] [Indexed: 08/13/2024] Open
Abstract
INTRODUCTION The purpose of this study is to assess the real-life efficacy and tolerance of a new preservative-free, surfactant-free latanoprost (PFSF-LAT) formulation. METHODS Retrospective, multicentre, non-comparative, observational study in patients with ocular hypertension or open angle glaucoma, naïve or non-naïve to previous intraocular pressure (IOP)-lowering treatment, and treated for at least 3 months with the study eye drop. IOP for worse eye, ocular signs and symptoms, and concomitant use of artificial tears were collected at study drug initiation and at last visit under treatment. Reasons for discontinuing the study eye drop (if relevant) and investigators' satisfaction were also assessed. RESULTS In the per protocol population (103 eyes; 63 naïve, 39 switched, 1 not classified because of missing data), IOP decreased significantly (p < 0.001) from 21.6 ± 5.0 mmHg at baseline to 16.1 ± 3.5 mmHg at the end of the study (mean reduction of - 5.5 ± 4.6 mmHg; - 25.5%). IOP in naïve patients was significantly improved, with a mean reduction of 7.1 mmHg (- 30.7%), which was within expected latanoprost IOP-lowering effect. Interestingly, in previously treated patients, switching to PFSF-LAT also allowed for a further 2.9 mmHg decrease in IOP (p < 0.001). The incidence of ocular side effects at study initiation was significantly (p < 0.001) reduced from 31.1% to 11.3% in the overall population, and from 65.0% to 7.5% in switched patients. This included conjunctival hyperaemia and superficial punctate keratitis (from 42.5% to 2.5% and from 37.5% to 2.5% in switched patients, respectively). According to investigators, tolerance and efficacy of the study eye drop were satisfactory or very satisfactory in 98.1% and 83.2% of patients, respectively. CONCLUSION PFSF-LAT is an efficient treatment for patients with glaucoma with an improved tolerance profile. It can be considered as initial therapy in naïve patients or in patients with poor ocular tolerance to previous IOP-lowering eye drops.
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Affiliation(s)
- Laure Chauchat
- Laboratoires Horus Pharma, 22 Allée Camille Muffat, 06200, Nice, France.
| | - Camille Guerin
- Laboratoires Horus Pharma, 22 Allée Camille Muffat, 06200, Nice, France
| | - Hayette Rebika
- Laboratoires Horus Pharma, 22 Allée Camille Muffat, 06200, Nice, France
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Marwan Sahyoun
- Laboratoires Horus Pharma, 22 Allée Camille Muffat, 06200, Nice, France
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Messmer EM, Baudouin C, Benitez-Del-Castillo JM, Iester M, Anton A, Thygesen J, Topouzis F. Expert Consensus Recommendations for the Management of Ocular Surface Inflammation in Patients With Glaucoma. J Glaucoma 2024; 33:715-727. [PMID: 39018018 DOI: 10.1097/ijg.0000000000002465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/07/2024] [Indexed: 07/18/2024]
Abstract
PRCIS We have developed through a consensus process 24 clinical recommendations for the comprehensive management of ocular surface inflammation in glaucoma patients, including diagnostic criteria, prevention measures, and treatment strategies according to ocular surface disease severity. PURPOSE To obtain expert consensus on the diagnosis, prevention, and management of ocular surface inflammation (OSI) in patients with glaucoma. METHODS An international steering committee of glaucoma and/or ocular surface disease (OSD) experts and a wider faculty of members from the Educational Club of Ocular Surface and Glaucoma (ECOS-G) collaborated to develop clinical recommendations on best practice in the management of OSI in glaucoma patients using a nonanonymous interactive quasi-Delphi process. Clinical recommendations were formulated by the steering committee based on an analysis of the recent literature to determine unmet needs, together with a web-based interactive survey of faculty members' opinion in seven identified areas of OSI management in glaucoma. Topics included (1) diagnosis of OSD, (2) diagnosis of OSI, (3) causes of OSI, (4) impact of OSD/OSI, (5) prevention of OSI, (6) treatment of OSI, and (7) inflammation and the deep structures of the eye. Faculty members were invited to vote on the clinical recommendations, and the steering committee then determined whether consensus had been achieved. RESULTS Consensus was obtained on 24 clinical recommendations by 80%-100% of faculty members. There was consensus that OSI should be investigated in all glaucoma patients. The main prevention measure in glaucoma patients with pre-existing OSD was the elimination/minimisation of preserved medications, especially BAK-preserved eye drops. A subtractive treatment strategy rather than an additive strategy is recommended according to OSI/OSD severity to improve the ocular health and/or before glaucoma surgery. CONCLUSION These recommendations for the management of OSI in glaucoma should be useful to guide decision-making in clinical practice.
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Affiliation(s)
| | - Christophe Baudouin
- Quinze-Vingts National Ophthalmology Hospital, INSERM-DGOS CIC 1423, IHU Foresight
- Sorbonne Université, INSERM, CNRS, Institut de La Vision, Paris
- Department of Ophthalmology, Ambroise Paré Hospital, APHP, Université de Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
| | | | - Michele Iester
- Clinica Oculistica, Department Of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alfonso Anton
- Hospital de l'Esperança, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut Català de Retina, Barcelona, Spain
| | - John Thygesen
- Department of Ophthalmology, Glaucoma Services in Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Fotis Topouzis
- First Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Baudouin C, Misiuk-Hojlo M, Benitez-Del-Castillo-Sanchez JM, Clarke J, Anton A, Figueiredo A, Thygesen J, Wierzbowska J, Stalmans I. FAST® questionnaire for identifying glaucoma patients at risk for ocular surface disease. Eur J Ophthalmol 2024; 34:1443-1449. [PMID: 38385355 DOI: 10.1177/11206721231222939] [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] [Indexed: 02/23/2024]
Abstract
OBJECTIVES To evaluate the validity and reliability of the new Fast Assessment of the Ocular Surface Trouble (FAST®) questionnaire for identifying glaucoma or ocular hypertension (OHT) patients at risk of ocular surface disease (OSD). METHODS A multicenter, international, cross-sectional, epidemiological survey evaluated the most accurate interview items and ocular signs on the initial 14-item version of FAST® to develop a shorter version for routine, quick clinical use. Rasch analysis and least absolute shrinkage and selection operator (LASSO) method was used to reduce the number of items on the questionnaire. Sensitivity and specificity of FAST® were assessed with receiver operating characteristic (ROC) curves for the detection of OSD with the questionnaire and ophthalmic assessment. RESULTS A total of 2308 eyes (1154 patients) were analyzed in this study by 92 ophthalmologists. The initial version of the FAST® indicated 60% of the subjects had OSD. Rasch analysis allowed removal of some clinical signs. The LASSO method allowed elimination of some items from the original questionnaire for a 9-item and a 6-item version of FAST®. For the 6-item questionnaire, the sensitivity and specificity were 71.9% and 74.3% respectively and the area under the curve was 0.815. CONCLUSIONS The FAST® questionnaire is a valid and reliable tool for use in routine clinical practice and in clinical trials. The short versions of the questionnaire allow quick detection of the majority of patients with OHT or glaucoma at risk of dry eye.
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Affiliation(s)
- Christophe Baudouin
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, IHU FOReSIGHT, Paris, France
| | - Marta Misiuk-Hojlo
- Uniwersytecki Szpital Kliniczny, Wroclaw Medical University, Wrocław, Poland
| | | | - Jonathan Clarke
- Department of Glaucoma Services, Moorfields Eye Hospital, London, UK
| | - Alfonso Anton
- Departamento de Glaucoma, Institut Català de Retina, Barcelona, Spain
| | | | - John Thygesen
- Department of Ophthalmology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joanna Wierzbowska
- Ophthalmology Department, Military Institute of Medicine National Research Institute, Warsaw, Poland
| | - Ingeborg Stalmans
- Department of Neurosciences, Research Group Ophthalmology, Catholic University KU Leuven, Leuven, Belgium
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
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Bacharach J, Doan LV, Stephens KG, Usner DW, Kothe AC, Katz LJ, Navratil T. Travoprost Intracameral Implant Demonstrates Superior IOP Lowering Versus Topical Prostaglandin Analog Monotherapy in Patients with Open-Angle Glaucoma or Ocular Hypertension. Ophthalmol Ther 2024; 13:2357-2367. [PMID: 38985408 PMCID: PMC11341799 DOI: 10.1007/s40123-024-00992-1] [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: 05/17/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024] Open
Abstract
INTRODUCTION This study was conducted to analyze and compare the intraocular pressure (IOP) treatment effect of the slow-eluting (SE) travoprost intracameral implant to the IOP treatment effect of topical prostaglandin analog (PGA) monotherapy in a subgroup of subjects who were on pre-study PGA monotherapy prior to enrollment in the two pivotal phase 3 trials of the travoprost intracameral implant. METHODS A combined study population of 133 subjects from two phase 3 trials, who were on topical PGA monotherapy at screening, subsequently underwent a washout period from their topical PGA, and then were randomized and administered an SE travoprost intracameral implant. The subjects were analyzed for the IOP treatment effects of the pre-study topical PGA monotherapy and the in-study SE travoprost intracameral implant. Paired t-tests were used to compare the difference in screening minus post-washout baseline IOP versus month 3 minus post-washout baseline IOP. The IOP-lowering efficacy in eyes administered an SE travoprost intracameral implant was compared to the IOP lowering in the same eyes while on a topical PGA monotherapy prior to study entry. RESULTS Pre-study topical PGA monotherapy and the SE travoprost intracameral implant demonstrated IOP treatment effects of -5.76 mmHg and -7.07 mmHg, respectively. The IOP-lowering treatment effect was significantly greater by 1.31 mmHg for the SE travoprost intracameral implant relative to pre-study PGA monotherapy (95% confidence interval: -2.01, -0.60; P = 0.0003). CONCLUSIONS The SE travoprost intracameral implant demonstrated superior IOP-lowering treatment effect versus pre-study topical PGA monotherapy with a superiority margin that was both statistically significant and clinically meaningful. The greater IOP reduction from baseline while on the SE implant versus pre-study topical PGA monotherapy may be a reflection of the optimized adherence and continuous elution of PGA therapy into the anterior chamber achieved with the SE travoprost intracameral implant. TRIAL REGISTRATION ClinicalTrials.gov identifiers, NCT03519386 and NCT03868124.
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Affiliation(s)
- Jason Bacharach
- North Bay Eye Associates, Inc., 104 Lynch Creek Way, Suite 15, Petaluma, CA, 94954, USA
| | - Long V Doan
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA
| | - Kerry G Stephens
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA
| | - Dale W Usner
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA
| | - Angela C Kothe
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA
| | - L Jay Katz
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA
| | - Tomas Navratil
- Glaukos Corporation, One Glaukos Way, Aliso Viejo, CA, 92656, USA.
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Oddone F, Tanga L, Giammaria S, Sabbatini L, Strianese A, Ferrazza M, Rossetti LM. 24-Hour Evaluation of the Effectiveness and Tolerability of Preservative-Free Tafluprost-Timolol Fixed Combination in Open-Angle Glaucoma or Ocular Hypertensive Patients Previously Treated with Preserved Latanoprost. Clin Ophthalmol 2024; 18:1751-1760. [PMID: 38919404 PMCID: PMC11197947 DOI: 10.2147/opth.s462672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/13/2024] [Indexed: 06/27/2024] Open
Abstract
Purpose The effectiveness, safety and tolerability of the preservative-free fixed combination of tafluprost and timolol (PF-TTFC) were evaluated over the 24-h in patients with open-angle glaucoma or ocular hypertension showing signs and symptoms of Ocular Surface Disease (OSD) and uncontrolled intraocular pressure (IOP) on prior benzalkonium chloride (BAK) - Latanoprost monotherapy. Methods In this multi-center, prospective, interventional, non-comparative clinical trial, patients treated with BAK-Latanoprost underwent 24-h IOP measurements (8 am, 11 am, 2 pm, 5 pm, 8 pm, 11 pm, 2 am, 5 am) at baseline and after 3 months from switch to PF-TTFC. Mean 24-h IOP and daytime (8 am-8 pm) vs nighttime (11 pm - 5 am) IOP were compared. Changes in OSD signs and symptoms, quality of life (QoL) and in-vivo corneal confocal microscopy (IVCM) were also evaluated. Results Thirty-eight patients were analyzed. The mean 24-h IOP significantly decreased after 3 months from 17.8 mmHg (95% CI: 17.1-18.6) to 15.3 mmHg (95% CI: 14.6-16.1, p < 0.001). IOP was significantly reduced both at daytime (p < 0.001) and nighttime (p < 0.001), with better IOP control at night [-2.9 (95% CI: -3.5 to -2.1) mmHg vs -2.3 (95% CI: -2.9 to -1.6) mmHg]. In 20 patients (52.6%), corneal fluorescein staining improved, whereas in 4 patients (10.5%) it worsened. Hyperemia has improved in 24 (63.3%) patients and worsened in 2 (5.3%). Breakup time, Schirmer test and QoL scores showed no changes. At IVCM, the mean corneal wing-cell size was found significantly decreased (p < 0.005). Conclusion The switch from BAK-Latanoprost to PF-TTFC significantly reduced IOP over the 24-h and improved OSD signs and symptoms.
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Affiliation(s)
| | | | | | - Lorenzo Sabbatini
- Eye Clinic, ASST Santi Paolo E Carlo, University of Milan, Milan, Italy
| | - Alfonso Strianese
- Eye Clinic, ASST Santi Paolo E Carlo, University of Milan, Milan, Italy
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Cordeiro MF, Denis P, Astarita C, Belsey J, Rivas M, García-Feijoo J. Prevalence of comorbidities with the potential to increase the risk of nonadherence to topical ocular hypotensive medication in patients with open-angle glaucoma. Curr Med Res Opin 2024; 40:647-655. [PMID: 38410906 DOI: 10.1080/03007995.2024.2322048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/19/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To evaluate the prevalence of comorbidities that may limit or prevent adherence to topical ocular hypotensive therapy in patients with open-angle glaucoma (OAG). METHODS The UK Clinical Practice Research Datalink (CPRD) database of primary and secondary care and prescription records was analyzed to identify patients with a first (index) diagnosis of OAG during 2016-2020. The primary care records of these patients were screened for diagnostic terms linked to prespecified (qualifying) comorbidities considered to have the potential to impact patients' ability to instill eye drops. The prevalence of each of 10 categories of qualifying comorbidity recorded within the period from 5 years before to 2 years after the index OAG diagnosis was analyzed. RESULTS A total of 100,968 patients with OAG were included in the analysis. Among the patients in the OAG cohort, 13,962 (13.8%) were aged 40-54 years, 32,145 (31.8%) were aged 55-69 years, 42,042 (41.6%) were aged 70-84 years, and 12,819 (12.7%) were aged 85+ years. Within the OAG population, 82.7%, 14.6%, and 2.7% of patients had no category, one category, and two or more categories of qualifying comorbidity, respectively. Qualifying comorbidities were most common in older patients. The most prevalent qualifying comorbidities were categorized as degenerative, traumatic, or pathological central nervous system disorder disrupting cognitive function (5.2%), movement disorder (4.4%), and low vision (4.1%). The prevalence of arthropathies and injuries affecting upper limbs (including arthritis in the hands) was 2.4%. CONCLUSIONS The presence of comorbidities should be considered when determining whether eye drops are suitable treatment for glaucoma. Neurodegenerative disease affecting cognition and memory, motor disease, and low vision are common comorbidities that may impact adherence to eye drops, and affected patients may benefit from non-drop treatment modalities.
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Affiliation(s)
- M Francesca Cordeiro
- Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, UK
- Glaucoma & Retinal Neurodegeneration Research Group, Institute of Ophthalmology, University College London, London, UK
| | - Philippe Denis
- Service d'Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | | | | | | | - Julián García-Feijoo
- Department of Ophthalmology, San Carlos Clinical Hospital, UCM, Instituto de Investigaciones Oftalmologicas Ramon Castroviejo, Madrid, Spain
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Motta GS, da Costa Andrade J, Kasahara N. How glaucoma patients balance between the advantages and disadvantages of acceptance to the recommended treatment regimen in real-life: Perspectives from a middle-income country. Pharmacoepidemiol Drug Saf 2024; 33:e5771. [PMID: 38419142 DOI: 10.1002/pds.5771] [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: 07/28/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Patients with primary open-angle glaucoma (POAG) are required to take long-term treatments with topical medications to halt disease progression. This cross-sectional survey aimed to describe the level of acceptance of Brazilian patients toward the long-term treatment with eyedrops and to find possible correlates of high acceptance. METHODS POAG patients were recruited from the Glaucoma Service-Santa Casa of Sao Paulo, Sao Paulo, Brazil. Clinical and demographic data were retrieved from participants' electronic records. All patients answered the ACCEPT© questionnaire. This is a generic patient-reported outcome questionnaire specifically developed to assess patients' acceptance of long-term medications and not adherence. Summed scores and those for each domain were calculated to range from 0 to 100 with a higher score indicating greater acceptance. RESULTS The sample comprised 96 patients with POAG. The mean age was 63.2 ± 8.9 years; 48 were male and 48 female; 55 (57.3%) were white, 36 (37.5%) African-Brazilian, and 5 (5.2%) were of mixed color; most patients (97.9%) had less than high school degree and all had a family income CONCLUSIONS In this cohort of Brazilian patients with glaucoma, acceptance of treatment was high. Patients seems to have noticed more benefits than risks to the recommended treatment regimen.
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Affiliation(s)
- Guilherme Samomiya Motta
- Department of Ophthalmology, Irmandade da Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil
| | - Julia da Costa Andrade
- Department of Ophthalmology, Irmandade da Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil
| | - Niro Kasahara
- Department of Ophthalmology, Irmandade da Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil
- Department of Ophthalmology, Santa Casa de Sao Paulo School of Medical Sciences, Sao Paulo, Brazil
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Vanathi M. Glaucoma and ocular surface. Indian J Ophthalmol 2024; 72:305-306. [PMID: 38421286 PMCID: PMC11001231 DOI: 10.4103/ijo.ijo_376_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Affiliation(s)
- M Vanathi
- Cornea and Ocular Surface, Cataract and Refractive Services, Dr. R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India E-mail:
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Konstas AG, Boboridis KG, Athanasopoulos GP, Haidich AB, Voudouragkaki IC, Pagkalidou E, Katsanos A, Katz LJ. Changing from preserved, to preservative-free cyclosporine 0.1% enhanced triple glaucoma therapy: impact on ocular surface disease-a randomized controlled trial. Eye (Lond) 2023; 37:3666-3674. [PMID: 37221362 PMCID: PMC10686389 DOI: 10.1038/s41433-023-02578-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/09/2023] [Accepted: 05/11/2023] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE Halting and reversing glaucoma therapy-related ocular surface disease (GTR-OSD) will improve the success of long-term medical therapy, impacting millions of patients worldwide. METHODS A single-centre, masked, prospective, placebo-controlled, crossover trial of 41 well-controlled open-angle glaucoma subjects with moderate to severe GTR-OSD on preserved latanoprost and dorzolamide/timolol fixed combination (DTFC) therapy was conducted. Subjects were randomized to preservative-free (PF) tafluprost and DTFC with either placebo or cyclosporine 0.1% drops for 6 months and were then crossed over to the opposite therapy. Oxford score of ocular staining was the primary outcome; osmolarity, matrix-metalloproteinase-9 (MMP-9) testing, tear film break-up time (TFBUT), meibomian gland dysfunction (MGD), punctum evaluation, adverse events and diurnal intraocular pressure (IOP) comprised secondary outcomes. RESULTS GTR-OSD findings improved with PF therapy. At 6 months the triple PF with placebo group showed improvement compared to baseline in mean Oxford score (mean difference [MD]:-3.76; 95% confidence interval [CI]:-4.74 to -2.77; p < 0.001), osmolarity (MD:-21.93; 95%CI:-27.61 to -16.24 mOsm/l; p < 0.001), punctum stenosis (p = 0.008) and conjunctival hyperaemia (p < 0.001). Similar improvements occurred in the cyclosporine enhanced period, which also provided greater improvement in MMP-9 positivity (24 vs 66%; p < 0.001) and TFBUT (p = 0.022). The cyclosporine group was superior vs placebo in mean Oxford score (MD:-0.78; 95%CI:-1.40 to -0.15); p < 0.001), itchiness and objective adverse events (p = 0.034). Cyclosporine elicited more stinging vs placebo (63 vs 24%; p < 0.001). Both PF regimens reduced mean diurnal IOP more than preserved therapy (14.7 vs 15.9 mmHg; p < 0.001). CONCLUSIONS Changing from preserved to PF glaucoma medications improves ocular surface health and IOP control. Topical cyclosporine 0.1% further reverses GTR-OSD.
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Affiliation(s)
| | - Konstadinos G Boboridis
- 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios P Athanasopoulos
- 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Epidemiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Irini C Voudouragkaki
- 1st University Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Pagkalidou
- Department of Epidemiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Katsanos
- Department of Ophthalmology, University of Ioannina, Ioannina, Greece
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
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Nijm LM, Schweitzer J, Gould Blackmore J. Glaucoma and Dry Eye Disease: Opportunity to Assess and Treat. Clin Ophthalmol 2023; 17:3063-3076. [PMID: 37869041 PMCID: PMC10590113 DOI: 10.2147/opth.s420932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/07/2023] [Indexed: 10/24/2023] Open
Abstract
Dry eye disease (DED) has been found to occur at a higher prevalence in individuals with glaucoma than in individuals without glaucoma. The relationship between glaucoma and DED may be, in part, a result of glaucoma therapy. Greater number of antiglaucoma medications used and greater number of antiglaucoma eyedrops instilled per day have been associated with ocular surface disease in patients with glaucoma. Use of antiglaucoma medication has also been associated with higher levels of ocular surface inflammatory markers and ocular surface alterations. There is evidence to suggest that antiglaucoma medications with preservatives and, to some extent, antiglaucoma medication formulations without preservatives may contribute to ocular surface signs and symptoms. Trabeculectomy for glaucoma has also been associated with ocular surface signs related to DED; however, there may be benefits of trabeculectomy and other procedures for glaucoma due to reduced use of antiglaucoma medications. Patients with glaucoma with ocular surface disease have been found to have greater ocular surface symptoms, poorer vision-related quality of life, and poorer antiglaucoma medication adherence compared with patients with glaucoma without ocular surface disease. Because of the potential negative impact of DED on patients with glaucoma, patients with glaucoma may benefit from evaluation for DED. Management of DED in patients with glaucoma may include modifications to antiglaucoma medications and use of treatments for DED.
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Affiliation(s)
- Lisa M Nijm
- Warrenville EyeCare and LASIK, Warrenville, IL, USA
- Department of Ophthalmology and Visual Sciences, University of Illinois Eye and Ear Infirmary, Chicago, IL, USA
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Bacharach J, Ahmed IIK, Sharpe ED, Korenfeld MS, Zhang S, Baudouin C. Preservative-Free versus Benzalkonium Chloride-Preserved Latanoprost Ophthalmic Solution in Patients with Primary Open-Angle Glaucoma or Ocular Hypertension: A Phase 3 US Clinical Trial. Clin Ophthalmol 2023; 17:2575-2588. [PMID: 37674591 PMCID: PMC10478989 DOI: 10.2147/opth.s414015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023] Open
Abstract
Purpose To evaluate the safety and efficacy of a preservative-free latanoprost 0.005% formulation (T2345) in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT) compared to benzalkonium chloride-preserved latanoprost 0.005% (BPL) formulation in the United States (US). Patients and Methods A prospective, randomized, multicenter, observer-masked, parallel-group study enrolled 335 patients diagnosed with POAG or OHT from 31 US sites who had adequately controlled intraocular pressure (IOP; ≤18 mm Hg) with latanoprost monotherapy. After a ≥72-hour washout period, patients were randomized to T2345 (n=165) or BPL (n=170) groups. Study drugs were dosed once-daily from Day 0 to Day 84 in one or both eyes. The study eye was the eye with lower IOP at baseline. The primary efficacy measure was the between-group comparison of the mean IOP values in the study eye at each time point (8 AM, 10 AM, and 4 PM on Days 15, 42, and 84). Safety measurements included ocular and systemic treatment-emergent adverse events (TEAEs). Results Both T2345 and BPL adequately controlled IOP with 95% CIs within 1.5 mm Hg in the study eye at all assessed time points. The percentages of patients with diurnal IOP <18 mm Hg at Day 84 were 73.1% vs 78.7% for the T2345 and BPL groups, respectively. Adverse events were generally mild-to-moderate and primarily ocular. Fewer patients in the T2345 group experienced ocular TEAEs (13.9% vs 22.5%, respectively) and TEAEs with a suspected relationship to the study medication compared with the BPL group (5.5% vs 11.8%, respectively). The most common ocular TEAEs were instillation site pain and conjunctival hyperemia. Conclusion In patients with POAG or OHT, both T2345 and BPL maintained IOP at or below clinically meaningful values for the duration of the study. T2345 showed a favorable safety profile, with numerically lower incidences of ocular TEAEs than BPL.
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Affiliation(s)
| | | | | | | | | | - Christophe Baudouin
- Quinze-Vingts National Ophthalmology Hospital & Vision Institute, Paris Saclay-Versailles-Saint Quentin University, IHU Foresight, Paris, France
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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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Belie NY, Ayele FA, Mengist B, Alemayehu AM, Assem AS, Fekadu SA, Yibekal BT. Patients' Satisfaction with Topical Anti-Glaucoma Medications and Associated Factors at Gondar University Tertiary Eye Care and Training Center, Northwest Ethiopia, 2021. CLINICAL OPTOMETRY 2023; 15:139-146. [PMID: 37361634 PMCID: PMC10289171 DOI: 10.2147/opto.s411390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023]
Abstract
Background Glaucoma is one of the leading cause of global irreversible blindness if left untreated. Satisfaction is a multifaceted outcome based on sufficient information and encouragement from the practitioner and based on the medications' nature. Determining patients' satisfaction is essential to increase their courage in their long-time follow-up of medical care. Objective To assess Patients' satisfaction with topical anti-glaucoma medications and associated factors among glaucoma patients at Gondar University Tertiary Eye Care and Training Center, Northwest Ethiopia. Methods Hospital-based cross-sectional study was conducted from June 30 to August 27, 2021, among 395 glaucoma patients at Gondar University Tertiary Eye Care and Training Center. Data was entered into Epi info version 7 and exported to SPSS version 26 software for analysis. A Binary logistic regression model was used to determine factors associated with satisfaction with topical anti-glaucoma medications. Statistical significance was considered when p-value < 0.05. Results A total of 395 study subjects participated in the study with a response rate of 93.38%. The overall satisfaction with topical anti-glaucoma medication was 62.5% with 95% CI: (57.5-67.8%). The absence of ocular side effects (AOR=5.39, 95% CI: 2.35-12.37) and the absence of ocular surface diseases (AOR=4.12, 95% CI: 1.69-10.09) were significantly associated with patient satisfaction. Conclusion More than half of the study participants were satisfied with topical anti-glaucoma medications. The absence of ocular side effects and absence of Ocular surface diseases were significantly associated with patient satisfaction with anti-glaucoma medication.
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Affiliation(s)
- Natnael Yeneneh Belie
- Department of Optometry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fisseha Admassu Ayele
- Department of Ophthalmology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belayneh Mengist
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Abiy Maru Alemayehu
- Department of Optometry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abel Sinshaw Assem
- Department of Optometry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sofonias Addis Fekadu
- Department of Optometry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Betelhem Temesgen Yibekal
- Department of Optometry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Scelfo C, ElSheikh RH, Shamim MM, Abbasian J, Ghaffarieh A, Elhusseiny AM. Ocular Surface Disease in Glaucoma Patients. Curr Eye Res 2023; 48:219-230. [PMID: 35179417 DOI: 10.1080/02713683.2022.2041041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To review the most recent studies in the literature regarding the ocular surface in glaucoma patients and treatment options aimed to reduce ocular surface disease in this population. METHODS We performed a literature search in the electronic databases of PubMed CENT RAL, Google Scholar, EMBASE the Register of Controlled Trials, and Ovid MEDLINE using the following terms: "ocular surface", "dry eye", "glaucoma", "selective laser trabeculoplasty", "glaucoma surgery", "preservatives", "preservative free", "ocular surface disease index", "tear break up time", "MMP-9" and "conjunctival hyperemia". RESULTS Over the last several years, several studies have demonstrated the changes to the ocular surface in the setting of glaucoma, the best tests for markers of dry eye, and how management can be altered to help address ocular surface disease routinely or in preparation for glaucoma surgery. CONCLUSION Ocular surface disease in the glaucoma patient population is widely recognized. It should be addressed to maximize patient compliance and quality of life.
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Affiliation(s)
- Christina Scelfo
- Department of Ophthalmology, Boston Children's Hospital, Hawthorne, NY, USA
| | - Reem H ElSheikh
- Department of Ophthalmology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Muhammad M Shamim
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Javaneh Abbasian
- Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Alireza Ghaffarieh
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Lazreg S, Garout R, Boulanab F, Aberkane D, Djabour M, Boudedja H, Acheli A, Derdour A, Zine El Abidine N, Ghemri N. [Ocular surface disease in glaucoma patients: Expert opinion and management algorithm in Algeria]. J Fr Ophtalmol 2023; 46:152-162. [PMID: 36642596 DOI: 10.1016/j.jfo.2022.07.025] [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: 04/10/2022] [Revised: 06/23/2022] [Accepted: 07/25/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The main goal of treatment for any glaucoma patient is to reduce the intraocular pressure. Unfortunately, the long-term use of glaucoma medications causes deleterious effects on the ocular surface, leading to impaired quality of life and failed glaucoma surgery. In addition, adverse effects of medications are a barrier to adherence and compliance, and this directly affects efficacy. It is therefore essential to regularly assess the ocular surface of glaucoma patients in order to detect any signs of damage early and act accordingly. Although the TFOS DEWS 2 now offers a strategy for diagnosing ocular surface pathologies, some examinations are unfortunately not feasible in Algeria due to lack of time and/or knowledge on the part of some ophthalmologists or are simply inaccessible to others. METHODS Algerian experts (members of the ACOS club) met for the purpose of proposing an algorithm for the management of Algerian glaucoma patients, based on the recommendations of the DEWS, their own practice and the results of a preliminary national survey of ophthalmologists. RESULTS The proposed algorithm allows evaluation of the ocular surface of the glaucoma patient in current practice by any Algerian ophthalmologist. CONCLUSION Management of glaucoma patients should include a systematic examination of the ocular surface. The choice of treatment should be determined by the ocular surface condition of the glaucoma patient.
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Affiliation(s)
| | | | | | | | - Mustapha Djabour
- Service d'ophtalmologie, CHU Mohamed Lamine Debaghine, Alger, Algérie
| | - Hakim Boudedja
- Service d'ophtalmologie, CHU Nafissa Hamoud, Alger, Algérie
| | - Asma Acheli
- Service d'ophtalmologie, CHU Mustapha Pacha, Alger, Algérie
| | - Amine Derdour
- Service d'ophtalmologie, EHS Hammou Boutlelis, Oran, Algérie
| | | | - Nadia Ghemri
- Service d'ophtalmologie, CHU Issad Hassani, Alger, Algérie
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Yıldırım N, Bozkurt B, Yüksel N, Ateş H, Altan-Yaycıoğlu R, Ocakoğlu Ö, Burcu A, Yalvaç I, Kemer ÖE, Orhan M. Prevalence of Ocular Surface Disease and Associated Risk Factors in Glaucoma Patients: A Survey Study of Ophthalmologists. Turk J Ophthalmol 2022; 52:302-308. [PMID: 36317767 PMCID: PMC9631508 DOI: 10.4274/tjo.galenos.2021.20726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES This survey study of ophthalmologists investigated the prevalence and clinical manifestations of ocular surface disease (OSD) in glaucoma patients, assessment methods used, risk factors, glaucoma drugs considered responsible, and treatment approaches. MATERIALS AND METHODS A questionnaire prepared jointly by the Turkish Ophthalmological Association Cornea and Ocular Surface Society and Glaucoma Society using SurveyMonkey was sent to ophthalmologists via e-mail. The distribution of parameters was compared with chi-square test and p<0.05 was considered statistically significant. RESULTS Forty-five percent of the ophthalmologists reported that OSD was evident in least 25% of their patients. The most common symptom was redness (91.9%), while the most common ocular surface finding was conjunctival hyperemia (75.6%). The tests considered to be the most important in ocular surface assessment were ocular staining (38.7%) and tear film break-up time (TBUT) (21.9%). Ninety percent of the physicians stated that the main cause of OSD was benzalkonium chloride (BAC) in medications. Prostaglandin analogs and alpha-2 agonists were reported to be the most common medications causing OSD. In case of OSD, the ophthalmologists often switch to a glaucoma drug from a different group (38%), a non-preservative glaucoma drug (33.7%) or a drug with a preservative other than BAC (20.4%). Most physicians prescribed artificial tears (84.6%). CONCLUSION In this cross-sectional survey study, ophthalmologists detected varying rates of OSD in glaucoma patients depending on chronic drug use and BAC exposure. Although ocular surface examination was performed by physicians, tests such as TBUT and ocular surface staining were rarely used. Detecting OSD in glaucoma patients and planning personalized treatment increase patient comfort, drug compliance, and treatment effectiveness. For this reason, it is important to prepare an algorithm for the management of comorbid OSD in glaucoma patients.
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Affiliation(s)
- Nilgün Yıldırım
- Eskişehir Osmangazi University Faculty of Medicine, Department of Ophthalmology, Eskişehir, Turkey,* Address for Correspondence: Eskişehir Osmangazi University Faculty of Medicine, Department of Ophthalmology, Eskişehir, Turkey E-mail:
| | - Banu Bozkurt
- Selçuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
| | - Nurşen Yüksel
- Kocaeli University Faculty of Medicine, Department of Ophthalmology, Kocaeli, Turkey
| | | | | | - Özcan Ocakoğlu
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
| | - Ayşe Burcu
- University of Health Sciences Turkey, Ankara Training and Research Hospital, Clinic of Ophthalmology, Ankara, Turkey
| | - Ilgaz Yalvaç
- Yeditepe University Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
| | - Özlem Evren Kemer
- University of Health Sciences Turkey, Ankara City Hospital, Clinic of Ophthalmology, Ankara, Turkey
| | - Mehmet Orhan
- Güven Hospital, Clinic of Ophthalmology, Ankara, Turkey
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Zhou X, Zhang X, Zhou D, Zhao Y, Duan X. A Narrative Review of Ocular Surface Disease Related to Anti-Glaucomatous Medications. Ophthalmol Ther 2022; 11:1681-1704. [PMID: 35943668 PMCID: PMC9437175 DOI: 10.1007/s40123-022-00557-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/29/2022] [Indexed: 01/31/2023] Open
Abstract
Topical anti-glaucomatous medications are still the most important measure to lower intraocular pressure. Large number of studies have confirmed that long-term use of anti-glaucomatous eye drops, especially containing benzalkonium chloride, a preservative, can cause or aggravate ocular surface injury. Ocular surface diseases damage the ocular microenvironmental health status, reduce the patients’ compliance with the treatment, and finally affect the treatment result. Therefore, the ocular surface management of patients with glaucoma is very important. This includes the selection of drugs that are better tolerated according to individual conditions, preservative-free formulations, drugs that protect against ocular surface disease, or selecting surgery and laser treatment, to prevent the damage to the ocular surface by topical anti-glaucomatous drugs.
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Affiliation(s)
- Xiaoyu Zhou
- Changsha Aier Eye Hospital, Changsha, Hunan Province, China.,The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Xinyue Zhang
- Changsha Aier Eye Hospital, Changsha, Hunan Province, China.,The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Dengming Zhou
- The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yang Zhao
- Changsha Aier Eye Hospital, Changsha, Hunan Province, China.,The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Xuanchu Duan
- Changsha Aier Eye Hospital, Changsha, Hunan Province, China. .,Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, China.
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Ucar F, Yener Hİ. Can bleeding in trabeculectomy be decreased? Effectiveness of brimonidine pre-treatment. Eur J Ophthalmol 2022; 32:3476-3481. [PMID: 35164600 DOI: 10.1177/11206721221080621] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the efficacy of preoperative topical brimonidine use to maintain visibility during trabeculectomy and control intraoperative bleeding and postoperative subconjunctival hemorrhage. METHODS The first group comprised 35 eyes of 34 patients administered brimonidine tartrate 0.15% (Brimogut, Bilim Ilac, Turkey) eye drops 6 and 3 min before surgery, and 33 eyes of 31 patients who received no medication for vasoconstriction formed the second group. Preoperative and postoperative photographs and operation video images were taken and vision analysis software used. Black-and-white images were obtained to identify the blood vessel and surface hemorrhage areas. The surface area of the hemorrhage was calculated by counting the black pixels with Image J software. RESULTS There was no significant difference between two groups in terms of baseline (preoperative) eye redness (p > 0.05). In the first group, the eye redness values were 344.7 ± 19.5 pixels preoperatively and 244.1 ± 23.3 pixels at the beginning of the surgery, respectively (p < 0.001). However, no significant change was observed in the second group in eye redness (348.2 ± 17.5 pixels preoperatively and 360.7 ± 26.8 pixels at the beginning of the surgery, p > 0.05). Cautery was used for an average of 11.91 ± 1.96 s in the first group and 25.57 ± 4.66 s in the second to control intraoperative bleeding (P < 0.001). CONCLUSION Preoperative topical brimonidine use in trabeculectomy surgery significantly decreased intraoperative bleeding and postoperative subconjunctival hemorrhage and facilitated bleeding control.
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Affiliation(s)
- Fikret Ucar
- Department of Ophthalmology, 590009Konyagoz Eye Hospital, Konya, Turkey
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Carnevale C, Riva I, Roberti G, Michelessi M, Tanga L, Verticchio Vercellin AC, Agnifili L, Manni G, Harris A, Quaranta L, Oddone F. Confocal Microscopy and Anterior Segment Optical Coherence Tomography Imaging of the Ocular Surface and Bleb Morphology in Medically and Surgically Treated Glaucoma Patients: A Review. Pharmaceuticals (Basel) 2021; 14:581. [PMID: 34207162 PMCID: PMC8234834 DOI: 10.3390/ph14060581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 01/21/2023] Open
Abstract
Glaucoma patients often suffer from ocular surface disease (OSD) caused by the chronic administration of topical anti-glaucoma medications, especially in cases of long-term therapy with preserved or multiple drugs. Additionally, glaucoma surgery may determine ocular surface changes related to the formation and location of the filtering bleb, the application of anti-mitotic agents, and the post-operative wound-healing processes within the conjunctiva. Recently, several studies have evaluated the role of advanced diagnostic imaging technologies such as in vivo confocal microscopy (IVCM) and anterior segment-optical coherence tomography (AS-OCT) in detecting microscopic and macroscopic features of glaucoma therapy-related OSD. Their clinical applications are still being explored, with recent particular attention paid to analyzing the effects of new drug formulations and of minimally invasive surgical procedures on the ocular surface status. In this review, we summarize the current knowledge about the main changes of the ocular surface identified at IVCM and AS-OCT in glaucoma patients under medical therapy, or after surgical treatment.
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Affiliation(s)
- Carmela Carnevale
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Ivano Riva
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia—IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy; (I.R.); (L.Q.)
| | - Gloria Roberti
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Manuele Michelessi
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Lucia Tanga
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Alice C. Verticchio Vercellin
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA; (A.C.V.V.); (A.H.)
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. d’Annunzio of Chieti—Pescara, 66100 Chieti, Italy;
| | - Gianluca Manni
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA; (A.C.V.V.); (A.H.)
| | - Luciano Quaranta
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia—IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy; (I.R.); (L.Q.)
| | - Francesco Oddone
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
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20
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Harasymowycz P, Hutnik C, Rouland JF, Negrete FJM, Economou MA, Denis P, Baudouin C. Preserved Versus Preservative-Free Latanoprost for the Treatment of Glaucoma and Ocular Hypertension: A Post Hoc Pooled Analysis. Adv Ther 2021; 38:3019-3031. [PMID: 33891269 PMCID: PMC8189977 DOI: 10.1007/s12325-021-01731-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/25/2021] [Indexed: 01/24/2023]
Abstract
Introduction To compare the tolerability and efficacy of a preservative-containing latanoprost (PCL) to a preservative-free formulation of latanoprost (PFL) in patients with open-angle glaucoma or ocular hypertension. Methods A pooled analysis was performed of data from five published studies. The primary outcome was tolerability as evaluated by the severity of hyperemia. The secondary objectives were patient tolerance based on a composite ocular surface disease (OSD) score arising from ocular signs and symptoms, patient and investigator satisfaction, and a comparison of IOP-lowering efficacy. Results There were three randomized controlled trials and two observational studies included in the analysis. Conjunctival hyperemia improved significantly in 25.6% (388) of patients switched to the PFL group versus 11.7% (117) of patients switched to the PCL group (p < 0.001). PFL was two times superior to PCL in reducing ocular hyperemia (odds ratio = 1.96; p < 0.001). The mean OSD composite score decreased by 32.2% in patients switched to the PFL group and 14.1% in the PCL group (p < 0.001). At 3 months, the mean IOP was similar between groups (p = 0.312). Conclusion This post hoc pooled analysis confirmed the findings of the individual studies that PFL is as efficacious at reducing IOP as PCL but better tolerated. After switching to PFL, there was twice the improvement in the OSD composite score. PFL was twice as effective at reducing ocular hyperemia and other ocular signs. These findings suggest that PFL has features that may improve patient compliance, thereby potentially improving the IOP-lowering efficacy on a long-term basis. Preservatives in eye drops for glaucoma can cause side effects such as stinging and eye redness. These side effects can cause some patients to reduce the frequency of the drops as prescribed or stop using the drops. One of the most common drops for glaucoma is latanoprost. This study evaluated whether a preservative-free latanoprost (PFL) is as effective as preservative-containing latanoprost (PCL) for reducing eye pressure and whether PFL is better tolerated in patients with glaucoma. The results of the study indicated that PFL was as effective as PCL for reducing eye pressure. The results also indicated PFL was much better at reducing the side effects related to PCL. For example PFL reduces eye redness up to twofold compared to PCL. By reducing the side effects associated with PCL patients may continue to take their glaucoma drops as directed and thereby reduce the risk of vision loss from glaucoma.
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