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Srivastava K, Bhatnagar KR, Shakrawal J, Tandon M, Jaisingh K, Pandey L, Roy F. Ocular surface changes in primary open-angle glaucoma on anti-glaucoma medications versus treatment-naïve patients. Indian J Ophthalmol 2024; 72:374-380. [PMID: 38099355 PMCID: PMC11001248 DOI: 10.4103/ijo.ijo_618_23] [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: 03/02/2023] [Revised: 07/23/2023] [Accepted: 08/05/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE To examine the ocular surface disease in primary open-angle glaucoma (POAG) patients already on treatment versus POAG patients without treatment. METHODS A prospective cohort study was conducted on 120 eyes of 60 POAG patients: 60 treatment-naïve eyes (group I) and 60 eyes already on topical anti-glaucoma medications (AGMs) (group II). All patients had filled out the Ocular Surface Disease Index (OSDI) questionnaire and underwent a comprehensive glaucoma workup. Tear break-up time (TBUT) test, Schirmer's test (type I), corneal sensitivity, anterior segment-optical coherence tomography (AS-OCT), and corneal and conjunctival staining were done at day 1, 1 month, 3 months, 6 months, and 12 months follow-up. RESULTS On presentation, TBUT, Schirmer's test, tear meniscus height (TMH), and tear meniscus depth (TMD) were significantly higher in group I compared to group II. No significant difference was noted in OSDI score, corneal sensitivity, and tear meniscus area (TMA) between the groups on presentation. Both, lissamine green and rose bengal staining, had higher grades in group II compared to group I. Worsening of ocular surface disease was noted in both groups on follow-up. OSDI score, TBUT, Schirmer's test, TMH, and TMD had better values in group I in comparison to group II on follow-up. CONCLUSION The study has identified glaucoma patients on AGMs to be more affected by dry eye disease (DED) compared to treatment-naive glaucoma patients. We found statistically significant differences in values of TBUT, Schirmer tests, lissamine and rose bengal staining, and AS-OCT parameters at baseline and 3, 6, and 12 months follow-up. OSDI scores showed significant differences at 6 and 12 months of follow-up. We recommend consideration of evaluation and management of DED/ocular surface disease in glaucoma patients on topical AGMs, particularly multiple drugs and doses.
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Affiliation(s)
| | | | - Jyoti Shakrawal
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
| | - Manjari Tandon
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
| | - Kirti Jaisingh
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
| | - Latika Pandey
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
| | - Falguni Roy
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
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Carnero E, Irigoyen-Bañegil C, Gutiérrez I, Extramiana L, Sabater AL, Moreno-Montañes J. Comparison of Transcriptomic Analysis of the Conjunctiva in Glaucoma-Treated Eyes with Dry Eyes and Healthy Controls. Biomolecules 2023; 14:30. [PMID: 38254630 PMCID: PMC10813521 DOI: 10.3390/biom14010030] [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: 10/06/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Ocular surface disease (OSD) associated with topical glaucoma drugs is a common issue impacting treatment adherence. We aimed to identify conjunctival transcriptomic changes in glaucoma and dry eye patients, comparing them to healthy controls. Bulbar conjunctival specimens were collected via impression cytology from 33 patients treated for glaucoma, 9 patients with dry eye, and 14 healthy controls. RNA extraction and bulk RNA sequencing were performed, followed by bioinformatics analysis to detect gene dysregulation. Ingenuity pathways analysis (IPA) identified pathways and biological processes associated with these transcriptomic changes. Sequencing analysis revealed 200 modified genes in glaucoma patients compared to healthy individuals, 233 differentially expressed genes in dry eye patients versus controls, and 650 genes in treated versus dry eye samples. In glaucoma patients, 79% of altered pathways were related to host defense, while dry eye patients showed a 39% involvement of host response, 15% in cellular proliferation and integrity, and 16% of mitochondrial dysfunction. These findings were validated through qRT-PCR. Glaucoma patients showed an intensified conjunctival immune response as a potential cause of OSD, whereas in dry eye patients, in addition to the immune response, other mechanisms such as mitochondrial dysfunction or reduced cellular proliferation were observed.
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Affiliation(s)
- Elena Carnero
- Department of Ophthalmology, Clínica Universidad de Navarra, University of Navarra, 31008 Pamplona, Navarra, Spain; (E.C.); (I.G.); (J.M.-M.)
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Navarra, Spain;
| | - Cristina Irigoyen-Bañegil
- Department of Ophthalmology, Clínica Universidad de Navarra, University of Navarra, 31008 Pamplona, Navarra, Spain; (E.C.); (I.G.); (J.M.-M.)
| | - Itziar Gutiérrez
- Department of Ophthalmology, Clínica Universidad de Navarra, University of Navarra, 31008 Pamplona, Navarra, Spain; (E.C.); (I.G.); (J.M.-M.)
| | - Leire Extramiana
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Navarra, Spain;
| | - Alfonso L. Sabater
- Department of Ophthalmology, Ocular Surface Center, Bascom Palmer Eye Institute, Miami, FL 33136, USA;
| | - Javier Moreno-Montañes
- Department of Ophthalmology, Clínica Universidad de Navarra, University of Navarra, 31008 Pamplona, Navarra, Spain; (E.C.); (I.G.); (J.M.-M.)
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Navarra, Spain;
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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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Kim JG, An JH, Cho SY, Lee CE, Shim KY, Jun JH. Efficacy of Topical 0.05% Cyclosporine A for Ocular Surface Disease Related to Topical Anti-Glaucoma Medications. J Ocul Pharmacol Ther 2023. [PMID: 37267211 DOI: 10.1089/jop.2022.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Purpose: We aimed to determine the therapeutic efficacy of 0.05% topical cyclosporine A (CsA) for chronic ocular surface disease (OSD) in patients using benzalkonium chloride (BAK)-preserved antiglaucoma eye drops. Methods: A prospective, randomized, paired-eye, controlled clinical trial was conducted with participants who had been instilling at least one BAK-preserved topical antiglaucoma drug in both eyes for at least 6 months. Topical CsA was only applied in randomly selected unilateral eyes. Visual field (VF) indices, ocular surface parameters, tear meniscus height (TMH), and matrix metalloproteinase-9 (MMP-9) immunoassay were evaluated at baseline and at 2 and 4 months. Results: Seventy eyes from 35 participants were included in the study. The Schirmer I, tear breakup time, and TMH increased by 4.5 ± 8.6 mm (P < 0.01), 5.0 ± 5.3 s (P < 0.001), and 85.4 ± 159.0 μm (P < 0.01) in the treated eyes at 4 months from baseline, respectively. The ocular staining score and MMP-9 positivity in the treated eyes decreased by 2.2 ± 1.3 (P < 0.001) and 0.7 ± 0.9 points (P < 0.001), respectively, at 4 months. In untreated eyes, only TMH increased by 41.4 ± 92.1 μm (P = 0.016) from baseline to 4 months. In VF indices, the tracking failure frequency was 19.09% ± 21.62%, and the test duration was 336.0 ± 79.5 s in the treated eyes at 4 months, which were lower than 34.37% ± 23.13% (P < 0.001) and 375.9 ± 70.7 s (P < 0.05) in the nontreated eyes. Conclusion: Application of topical 0.05% CsA significantly improved the OSD parameters and the reliability indices of VF tests. This study was registered with the Clinical Research Information Service (CRIS) (number KCT0007124).
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Affiliation(s)
- Jae-Gon Kim
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Republic of Korea
| | - Jae-Hong An
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Republic of Korea
| | - Soon Young Cho
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Republic of Korea
| | | | - Kyu Young Shim
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Republic of Korea
| | - Jong Hwa Jun
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Republic of Korea
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Factors influencing the effectiveness of trabeculectomy: following materials of the City Multidisciplinary Hospital No. 2. OPHTHALMOLOGY JOURNAL 2023. [DOI: 10.17816/ov159363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND: Despite the ever-expanding arsenal of IOP-lowering surgeries, trabeculectomy remains the most common procedure amongst them. Therefore, the identification of factors reducing its effectiveness and potentially being able to change the surgical treatment plan is of particular importance.
AIM: To identify factors reducing trabeculectomy effectiveness.
MATERIALS AND METHODS: The study group consisted of 443 consecutively enrolled patients who were operated in 20162020 in Saint Petersburg City Multidisciplinary Hospital No. 2 for primary open-angle decompensated glaucoma and then observed for 6 to 24 months. Using statistical research methods, factors that significantly affected the impact of the procedure were identified.
RESULTS: The main predictors of trabeculectomy failure following the order of decreasing importance of established relations (p) were: loss of effectiveness of the preceding IOP-lowering procedure (р = 0.0001), dry eye syndrome (р = 0.013), number of drop instillations per day (р = 0.041), and excessive preservative load due to unnecessarily aggressive topical glaucoma treatment (р = 0.039). An obvious demonstration of excessive therapy is a simultaneous administration of four IOP-lowering medications. It also causes scarring of the procedure area, especially in patients previously operated for glaucoma. Null preservative load and prostaglandin monotherapy are associated with guaranteed complete success of trabeculectomy. Unlike the intensity of medical glaucoma treatment, its duration does not have such a significant impact on trabeculectomy outcomes (р = 0.270). Close to a significant one is the relationship between poor surgical outcomes and advanced stages of the disease (р = 0.052).
CONCLUSIONS: The main factors affecting the effectiveness of trabeculectomy were failure of the previous IOP-lowering surgeries; concomitant dry eye syndrome, arising or being aggravated by unduly intense and prolonged pharmacological effects on the eye surface; as well as delayed appliance for surgical IOP normalization at advanced disease stages.
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Andole S, Senthil S. Ocular Surface Disease and Anti-Glaucoma Medications: Various features, Diagnosis, and Management Guidelines. Semin Ophthalmol 2023; 38:158-166. [PMID: 35915557 DOI: 10.1080/08820538.2022.2094714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Assessment of ocular surface in patients using anti-glaucoma medications (AGM) is rarely a priority for clinicians since glaucoma management targets intraocular pressure and preserves vision. This review summarizes the various adverse effects of topical AGM on the ocular surface and highlights the importance of ocular surface assessment in these patients. METHODS A literature search of articles (English only) on the subject matter was conducted focusing on recent articles published in the past 5 years. RESULTS The use of multiple anti-glaucoma medications in glaucoma patients increases patients' exposure to the drug and the preservatives present in these medications. Long-term use of these medications has deleterious effects on the conjunctiva, cornea, eyelids, and periocular tissues like trichiasis, entropion, symblepharon, forniceal shortening, punctate keratopathy, non-healing epithelial defects, and pannus. Treatment requires drug withdrawal or substitution by oral or topical non-preserved and less toxic preparations of AGMs. The ocular surface and symptoms can improve if the condition is diagnosed early and after drug withdrawal in over 90% of eyes. However, stopping or changing AGMs can often present with its own unique set of challenges in intra-ocular pressure control which may often need glaucoma surgery in close to 20% of eyes for IOP control. CONCLUSION Topical antiglaucoma medications (with their preservatives) can induce severe ocular surface and periorbital changes. Early identification and withdrawal of the offending drug/preservative can help to reverse the changes except in eyes with extensive cicatrization.
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Affiliation(s)
- Sowmya Andole
- VST Glaucoma Center, L V Prasad Eye Institute, Hyderabad, India
| | - Sirisha Senthil
- VST Glaucoma Center, L V Prasad Eye Institute, Hyderabad, India
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Parkkari M, Purola P, Uusitalo H. Ocular surface disease signs and symptoms of glaucoma patients and their relation to glaucoma medication in Finland. Eur J Ophthalmol 2022; 33:11206721221144339. [PMID: 36511236 PMCID: PMC9999283 DOI: 10.1177/11206721221144339] [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: 10/30/2021] [Accepted: 11/03/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the prevalence of ocular surface disease (OSD) signs and symptoms of glaucoma patients in private clinics in relation to topical glaucoma treatment and to compare them to non-glaucomatous population. METHODS A multicenter, cross-sectional study consisting of private ophthalmology clinic visits in southern Finland. Glaucoma patients had a diagnosis of primary open-angle glaucoma, pseudoexfoliation glaucoma, pigmentary glaucoma, or treated ocular hypertension. Control patients had no prior or current use of glaucoma medication. Recorded parameters included OSD signs and symptoms, used glaucoma medications during the past 6 months, and the product name, type, and duration of used antiglaucoma drugs. RESULTS Glaucoma patients (n = 564) showed higher severity of OSD sign parameters excluding Schirmer's test, as well as increased dry eye sensation compared to controls (n = 51). Beta-blockers and preservative-free prostaglandins had the smallest effect on all parameters. The increasing number of active compounds and administered eye drops per day showed an association with increasing severity of OSD signs, as well as dry eye and foreign body sensation. Duration of glaucoma medication showed no significant association with OSD signs or symptoms. CONCLUSION Glaucoma patients show higher prevalence of OSD signs and dry eye sensation compared to non-glaucomatous population. The use of preserved glaucoma medication, as well as high number of active compounds and eye drops increase the severity of these parameters. There are significant differences between the types of glaucoma medication used, and therefore the selection of them is important especially in patients suffering from OSD.
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Affiliation(s)
- Minna Parkkari
- Department of Ophthalmology, SILK, University of Tampere, Tampere, Finland
| | - Petri Purola
- Department of Ophthalmology, SILK, University of Tampere, Tampere, Finland
- Finnish Register of Visual Impairment, Finnish Federation of the Visually Impaired, Helsinki, Finland
| | - Hannu Uusitalo
- Department of Ophthalmology, SILK, University of Tampere, Tampere, Finland
- Finnish Register of Visual Impairment, Finnish Federation of the Visually Impaired, Helsinki, Finland
- Tauh Eye Center, Tampere, Finland
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Matossian C, Crowley M, Periman L, Sorkin S. Personalized Management of Dry Eye Disease: Beyond Artificial Tears. Clin Ophthalmol 2022; 16:3911-3918. [DOI: 10.2147/opth.s384819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022] Open
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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: 0] [Impact Index Per Article: 0] [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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Chang CCJ, Somohano K, Zemsky C, Uhlemann AC, Liebmann J, Cioffi GA, Al-Aswad LA, Lynch SV, Winn BJ. Topical Glaucoma Therapy Is Associated With Alterations of the Ocular Surface Microbiome. Invest Ophthalmol Vis Sci 2022; 63:32. [PMID: 36036910 PMCID: PMC9434984 DOI: 10.1167/iovs.63.9.32] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the ocular surface microbiome of patients with unilateral or asymmetric glaucoma being treated with topical ophthalmic medications in one eye and to determine whether microbial community changes were related to measures of ocular surface disease. Methods V3-V4 16S rRNA sequencing was conducted on ocular surface swabs collected from both eyes of 17 subjects: 10 patients with asymmetric/unilateral glaucoma using topical glaucoma therapy on only one eye and seven age-matched, healthy controls with no history of ocular disease or eyedrop use. Samples were categorized into three groups: patients’ glaucomatous eye treated with eyedrops, patients’ contralateral eye without eyedrops, and healthy control eyes. Comparisons were made for microbial diversity and composition, with differences in composition tested for association with ocular surface disease measures including tear meniscus height, tear break-up time, and Dry Eye Questionnaire. Results Samples obtained from the patients’ treated and untreated eyes both had significantly greater alpha-diversity and relative abundance of gram-negative organisms compared to healthy controls. The microbial composition of patient eyes was associated with decreased tear meniscus height and tear break-up time, whereas metagenomic predictions, based on 16S rRNA data, suggested increased synthesis of lipopolysaccharide. Conclusions The ocular surface microbiome of patients taking unilateral preserved glaucoma drops is characterized by a highly diverse array of gram-negative bacteria that is significantly different from the predominantly gram-positive microbes detected on healthy control eyes. These compositional differences were associated with decreased tear film measures and distinct inferred protein synthesis pathways, suggesting a potential link between microbial alterations and ocular surface inflammation.
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Affiliation(s)
- Chih-Chiun J Chang
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States
| | - Karina Somohano
- Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York, United States
| | - Christine Zemsky
- Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York, United States
| | - Anne-Catrin Uhlemann
- Department of Internal Medicine, Division of Infectious Disease, Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York, United States
| | - Jeffrey Liebmann
- Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York, United States
| | - George A Cioffi
- Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York, United States
| | - Lama A Al-Aswad
- Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York, United States.,Department of Ophthalmology, New York University Langone Health, New York, New York, United States
| | - Susan V Lynch
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, California, United States
| | - Bryan J Winn
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States.,Department of Ophthalmology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York, United States.,Ophthalmology Section, Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, United States
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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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Ansari E, Chappiti S, Pavicic-Astalos J, Pinto-Bonilla JC, Riva I, Sacchi M, Saénz-Francés F. Treatment of open-angle glaucoma and ocular hypertension with preservative-free tafluprost/timolol fixed-dose combination therapy: 6 case reports and clinical outcomes. BMC Ophthalmol 2022; 22:152. [PMID: 35366846 PMCID: PMC8977001 DOI: 10.1186/s12886-022-02361-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/20/2022] [Indexed: 01/11/2023] Open
Abstract
Abstract
Background
Treatment of open angle glaucoma (OAG) and/or ocular hypertension (OHT) focuses on achievement of target intraocular pressure (IOP), with the objective of slowing disease progression. However, ocular surface health is an important consideration in the optimization of treatment. We report 6 patient cases in which enhanced IOP control was achieved following appropriate management of ocular surface inflammation and a therapeutic switch to the preservative-free (PF) tafluprost (0.0015%)/timolol (0.5%) fixed-dose combination (FC).
Case presentation
Six patient cases, aged 48–74 years, presented with OAG or OHT. Each patient had signs and symptoms of ocular surface disease (OSD). Cases 1–3 were each receiving maximal medical therapy for OAG; regimens comprising prostaglandin analogue (PGA), β-blocker, carbonic anhydrase inhibitor (CAI) and α-2 agonist agents (including treatments containing preservative agent). Cases 1 and 2 reported IOP values ≥23 mmHg in each eye, and wide IOP fluctuations were identified when reviewing patient data concerning case 3 (11–20 mmHg). Maximal therapy was ceased and PF tafluprost/timolol FC was initiated, after which the signs and symptoms of OSD were improved and IOP was reduced (≤18 mmHg for cases 1–3) and stabilized. Cases 4 and 5 were diagnosed with OAG and case 6 had OHT. Each had symptoms and signs of OSD and were treated with a preserved PGA monotherapy (latanoprost 0.005% or bimatoprost 0.03%). At presentation, IOP was 24 mmHg in both eyes (case 4), ≥18 mmHg (case 5) and ≥ 22 mmHg (case 6). Following a switch to the PF tafluprost/timolol FC, OSD symptoms were improved and IOP was 14 mmHg (both eyes; case 4), ≤14 mmHg (case 5) and 16 mmHg (both eyes; case 6).
Conclusions
In addition to IOP-lowering efficacy, approaches to the management of OAG and OHT should consider the impact of treatment tolerability and the susceptibility of these patients to OSD. The presence of ocular surface inflammation appears to be detrimental to adherence and therefore to the effectiveness of topical medications. Addressing OSD through the use of PF FC formations, such as the PF tafluprost/timolol FC, reduces exposure to potentially toxic agents and facilitates improvements in IOP control.
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Dermenoudi M, Matsou A, Keskini C, Anastasopoulos E. Ocular Surface Disease Signs and Symptoms in Patients with Pseudoexfoliative Glaucoma: A Case—Control Study. Vision (Basel) 2022; 6:vision6010011. [PMID: 35225970 PMCID: PMC8883900 DOI: 10.3390/vision6010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose: The present study evaluates the differences in the prevalence of the signs and symptoms of ocular surface disease (OSD) in patients with PEX glaucoma (PEXG), compared to other glaucoma types (non-PEXG). Methods: Patients with non-PEXG and PEXG were prospectively examined for the presence and severity of OSD signs and questioned for symptoms using the OSDI (ocular surface disease index) questionnaire. Results: 116 patients were prospectively enrolled (58 non-PEXG and 58 PEXG). PEXG subjects who were older, had lower central corneal thickness (CCT) values, at a more advanced glaucoma stage and required more IOP lowering drops. OSD signs were prevalent in both groups: conjunctival hyperemia (74.5% non-PEXG vs. 94.8% PEXG), eyelid redness (70.7% vs. 96.6%), conjunctival (74.1% vs. 93.1%) and corneal fluorescein staining (81% vs. 93.1%) and abnormal TFBUT (82.8% vs. 87.9%). When adjusted for potential confounders, (older age, thinner CCT, more advanced glaucoma in PEXG) eyelid redness remained the only parameter significantly associated with PEXG, being 11 times more likely to occur in this group (p = 0.037). Conclusion: Subjects with PEXG presented a higher frequency of signs of OSD compared to other glaucoma types. When accounting for confounding factors, the only difference between the groups was the significantly higher presence (11 times more likely) of eyelid redness in PEXG, suggesting, in addition to glaucoma treatment, the impact of PEX on ocular surface integrity.
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Affiliation(s)
| | - Artemis Matsou
- Ophthalmology Department, Queen Victoria Hospital NHS Foundation Trust, East Grinstead RH19 3DZ, UK;
| | - Christina Keskini
- 1st Department of Ophthalmology, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece;
| | - Eleftherios Anastasopoulos
- 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece
- Correspondence: ; Tel.: +30-231-3323675; Fax: +30-231-0444105
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14
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Efficacy, Safety and Patient-Reported Outcomes with Preservative-Free (PF) Tafluprost or PF-Dorzolamide/Timolol Compared with Preserved Latanoprost: A Prospective Multicenter Study in Korean Glaucoma Patients with Ocular Surface Disease. Pharmaceuticals (Basel) 2022; 15:ph15020201. [PMID: 35215313 PMCID: PMC8874539 DOI: 10.3390/ph15020201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/20/2022] [Accepted: 02/03/2022] [Indexed: 12/16/2022] Open
Abstract
To compare the efficacy, patient-reported satisfaction, and safety of preservative-free (PF)-tafluprost, PF-dorzolamide/timolol and preservative-containing (P)-latanoprost in Korean glaucoma patients with ocular surface disease (OSD). In a multicenter, prospective, interventional, non-randomized, controlled 12-week trial, 107 eligible patients received PF-tafluprost (n = 37), PF-dorzolamide/timolol (n = 34), or P-latanoprost eye drops (n = 36). Outcomes included changes from baseline in OSD Index (OSDI) scores (primary endpoint), intraocular pressure (IOP), and patient-reported treatment satisfaction, and safety at 12 weeks. At 12 weeks, the mean total OSDI and subdomain (dry eye symptoms, visual-related function, environmental triggers) scores significantly improved from baseline with PF-tafluprost and PF-dorzolamide/timolol, but not with P-latanoprost. Significantly more PF-tafluprost than P-latanoprost recipients reported ‘highly improved/improved’ satisfaction (no significant difference between PF-dorzolamide/timolol and P-latanoprost). IOP changes were comparable among all three treatment groups. No new safety concerns were observed. PF-tafluprost and PF-dorzolamide/timolol showed statistically and clinically significant reductions in OSDI compared with P-latanoprost in Korean glaucoma patients with OSD.
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15
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Ye Y, Xu Y, Yang Y, Fan Y, Liu P, Yu K, Yu M. Wide Corneal Epithelial Thickness Mapping in Eyes With Topical Antiglaucoma Therapy Using Optical Coherence Tomography. Transl Vis Sci Technol 2022; 11:4. [PMID: 34985508 PMCID: PMC8742533 DOI: 10.1167/tvst.11.1.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to assess the corneal epithelial thickness (CET) of the 9-mm diameter zone in patients treated using topical antiglaucoma medications and to evaluate the factors associated with CET changes. Methods Seventy-five patients treated using topical antiglaucoma medications and 65 healthy subjects were included in this cross-sectional study. Each patient completed the Ocular Surface Disease Index (OSDI) questionnaire and underwent examinations including the Schirmer I test, tear breakup time (TBUT), and fluorescein staining. CET mapping of the 9-mm diameter zone was performed using RTVue XR. The CET of the different analyzed zones was compared between groups. The relationship between CET and confounding factors was investigated. Results The patient group had a significantly shorter TBUT, shorter Schirmer I test, and greater fluorescein staining than those of the control group (all P < 0.05). The mean CET of patients with glaucoma was significantly lower than that of controls in the central, paracentral, mid-peripheral, and peripheral zones (all P < 0.001). Age affected the CET in the paracentral, mid-peripheral, and peripheral zones (all P < 0.01). The number of medications affected the CET in the central, paracentral, and mid-peripheral zones (all P < 0.05). The duration of treatment affected the CET in the central and peripheral zones (all P < 0.05). Conclusions Use of topical IOP-lowering medications leads to epithelial thinning in the 9-mm diameter zone in glaucomatous eyes. Epithelial protection should be considered in older patients and patients treated with multiple medications from the early stages of long-term topical antiglaucoma therapy. Translational Relevance The 9-mm diameter CET mapping by using widefield optical coherence tomography (OCT) can be a valuable and convenient method to assess the ocular surface damage in patients with topical antiglaucoma therapy.
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Affiliation(s)
- Yiming Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yunzhi Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yangfan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yanmei Fan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Pingping Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Keming Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Minbin Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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16
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The role of trabeculectomy in the era of minimally invasive glaucoma surgery. Curr Opin Ophthalmol 2021; 33:112-118. [DOI: 10.1097/icu.0000000000000811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Maeng KJ, Lee K, Kim S, Park CK, Kim EW, Lee SY, Bae HW, Seong GJ, Kim CY. Effects of Glaucoma Medication on Dry Eye Syndrome and Quality of Life in Patients with Glaucoma. ACTA ACUST UNITED AC 2021; 35:467-475. [PMID: 34634864 PMCID: PMC8666262 DOI: 10.3341/kjo.2021.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/17/2021] [Indexed: 11/23/2022]
Abstract
Purpose To investigate ocular surface diseases and changes in the quality of life (QOL) of patients using glaucoma medications. Methods Participants were divided into the normal (31 individuals, 62 eyes) and glaucoma medication (30 patients, 60 eyes) groups. Changes in tear break-up time (TBUT), lipid layer thickness (LLT), corneal and conjunctival staining scores, ocular surface disease index (OSDI), and visual function questionnaire 25 (VFQ-25) score were assessed for 1 year. Results The change in mean LLT was lower in glaucomatous eyes than in control eyes (P = 0.019) after 1 year. The results of OSDI deteriorated (P' = 0.008), but conjunctival staining and Schirmer test results showed improvement in glaucomatous eyes compared to those in control eyes (P' =0.035 and 0.009, respectively). The average LLT decreased at 6 and 12 months, but there was no change at 24 months. In pairwise analysis, the decrease in LLT over the first 6 months was statistically significant (P < 0.001), and remained unchanged until 24 months. Among the VFQ items, scores for near activity and social function deteriorated over 1 year in the medication group (P' = 0.033 and 0.015, respectively). However, there was no difference in the total VFQ score. Conclusions Significant reduction in LLT and deterioration of OSDI were observed in the medication group compared to the control group. However, this deterioration was observed only in the first 6 months. There was no significant difference in the VFQ total score. Nonetheless, there were significant differences in near activity and social function between the control and medication groups. Therefore, the results of this study showed that although glaucoma medication worsened eye dryness, the change was limited and did not worsen the QOL. Glaucoma medication should be used with the consideration that they can limit near activity and social functioning.
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Affiliation(s)
- Kyung Joo Maeng
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kwanghyun Lee
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, Gyeonggi-do, South Korea
| | | | - Chan Keum Park
- Department of Ophthalmology, Maryknoll Hospital, Busan, South Korea
| | - Eun Woo Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea.,Myung-Gok Eye Research Institute, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Republic of Korea
| | - Sang Yeop Lee
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Republic of Korea
| | - Hyoung Won Bae
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Gong Je Seong
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Chan Yun Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
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18
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Wu JH, Wang TH, Huang JY, Su CC. Ocular Surface Disease in Glaucoma Patients Randomized to Benzalkonium Chloride-Containing Latanoprost and Preservative-Free Bimatoprost. J Ocul Pharmacol Ther 2021; 37:556-564. [PMID: 34610257 DOI: 10.1089/jop.2021.0071] [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: 01/29/2023] Open
Abstract
Purpose: To investigate the influence of benzalkonium chloride (BAK) on ocular surface disease (OSD) in glaucoma patients receiving ocular-hypotensive agent. Methods: Patients were randomized to receive BAK-containing latanoprost (Xalatan) or preservative-free bimatoprost (Lumigan PF). Intraocular pressure (IOP), basal Schirmer's test, noninvasive keratograph tear-breakup time (TBUT), conjunctival redness score (R score), OSD index (OSDI), and corneal Oxford staining were recorded and compared between the 2 groups at 1-month and 4-month visits. The influence of BAK was analyzed by a generalized estimating equation model. Results: We enrolled 74 and 76 eyes treated with latanoprost and bimatoprost, respectively. The IOP decreased in both groups, although greater reduction was observed for latanoprost (13.95 vs. 15.42 mmHg, P = 0.0264). There was a significantly negative association between tear flow and latanoprost use (β = -0.763, P = 0.0243). The first and average TBUT did not show intergroup differences, but the area with unstable tear film increased with latanoprost use and showed marginal significance at 4-month visit (9.33% vs. 5.94% P = 0.055). In both groups, OSDI decreased, whereas Oxford stain increased over time, and R scores showed improvement after transient increase in the first month. The bimatoprost group had significantly worse conjunctival hyperemia, whereas a negative association with conjunctival hyperemia was revealed for latanoprost use (R score-bulbar nasal: β = -0.045, P = 0.0423). Conclusions: BAK-containing latanoprost was associated with decreased tear secretion and may be associated with tear-film instability, whereas bimatoprost was associated with worse conjunctival hyperemia. Ocular surface side effects should be considered when prescribing BAK-containing medication to glaucoma patients.
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Affiliation(s)
- Jo-Hsuan Wu
- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California, San Diego, California, USA
| | - Tsing-Hong Wang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jehn-Yu Huang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Chia Su
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
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19
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Assessment of Corneal Epithelium Thickness in Glaucomatous Patients Undergoing Medical Treatment. J Glaucoma 2021; 30:44-49. [PMID: 32969915 DOI: 10.1097/ijg.0000000000001677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022]
Abstract
PRECIS Patients with glaucoma have reduced and irregular corneal epithelial thickness (CET) even if they do not report symptoms of dry eyes. The reduction of corneal epithelium affects equally the superior and inferior areas of the cornea. PURPOSE To evaluate CET parameters by means of anterior segment optical coherence tomography in glaucomatous patients undergoing medical treatment and compare them with CET parameters of controls. METHODS This was a cross-sectional study of 62 patients with primary open-angle or pseudoexfoliative glaucoma (study group) and 62 age-matched controls. Fourier-domain optical coherence tomography (RTVue) with a corneal adaptor module was used in the present study. Τhe pachymetry scan pattern was used to map the cornea and the software generated corneal thickness parameters were recorded. Simple comparisons between groups were performed and the correlations of CET parameters with parameters associated with medication use (treatment duration, number of medications and number of instillations) were assessed. RESULTS Mean age of the patients was 68±11.9 years in the glaucoma group and 65.5±8.5, years in the control group (P=0.17). Median number of instillations of medication was 2 (range, 1 to 6) for the glaucoma group. Central corneal thickness was 537.6±33.3 in the glaucoma group and 550.8±33.7 in the control group, respectively (P=0.028). The central CET was 48.8.±3.7 μm in the glaucoma group and 53.5±3.7 μm in the control group (P<0.001). Similarly, the average superior (2 to 7 mm) CET and the average inferior (2 to 7 mm) CET were almost equally reduced in the glaucoma group (45±4 vs. 49.6±3.3 μm, P<0.001 and 49±3.9 vs 53.5±3.7, P<0.001, respectively). No CET parameter was correlated with any of the treatment parameters. CONCLUSIONS Patients treated for glaucoma have uniformly reduced corneal epithelial thickness.
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20
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Lajmi H, Chelly Z, Choura R, Mansour KB, Hmaied W. Relationship between OSDI score and biomicroscopic ocular surface damages in glaucomatous patients treated with preserved antiglaucomatous eye drops. J Fr Ophtalmol 2021; 44:1326-1331. [PMID: 34325926 DOI: 10.1016/j.jfo.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE Our goal was to identify factors that may influence the OSDI score, in particular, ocular surface damage in patients on preserved glaucoma eye drops. METHODS This was a cross-sectional study of 155 glaucoma patients treated with preserved glaucoma eye drops. They all completed the "Ocular Surface Disease Index" (OSDI) questionnaire and underwent complete ophthalmological examination with precise evaluation of the status of the ocular surface. The assessment included Shirmer I testing, tear break up time (TBUT), eyelid, conjunctival and corneal examination with fluorescein and lissamine green staining. We analyzed factors that may influence the OSDI score and its relationship with the biomicroscopic signs. RESULTS Benzalkonium chloride (BAK) was used in 80% of cases. The OSDI score was≥13 in 61.3% of cases and classified as severe in 22.6% of cases. The biomicroscopic signs of ocular surface disease were at least minimal in 87.1% of cases. The severity of the OSDI score was statistically associated with patient age (P<0.001), treatment duration (P<0.001), multiple medications (P=0.011), and use of BAK (P=0.004). Blepharitis (P=0.013), Meibomian gland dysfunction (P=0.039), corneal neovascularization (P=0.025) and superficial punctate keratitis (SPK) (P=0.044) were retained as predictors of a pathological OSDI score. A disparity between the severity of symptoms and biomicroscopic signs was noted. CONCLUSION Symptoms and clinical signs are complementary for assessment of the various aspects of ocular surface disease. OSDI score is correlated with ethnicity, glaucoma treatment duration, number of medications, BAK use and clinical ocular surface changes, especially SPK.
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Affiliation(s)
- H Lajmi
- Ophthalmology department, FSI Hospital, La-Marsa, Tunisia.
| | - Z Chelly
- Ophthalmology department, FSI Hospital, La-Marsa, Tunisia
| | - R Choura
- Ophthalmology department, FSI Hospital, La-Marsa, Tunisia
| | - K B Mansour
- Ophthalmology department, FSI Hospital, La-Marsa, Tunisia
| | - W Hmaied
- Ophthalmology department, FSI Hospital, La-Marsa, Tunisia
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21
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Comparison of the Safety and Efficacy between Preserved and Preservative-Free Latanoprost and Preservative-Free Tafluprost. Pharmaceuticals (Basel) 2021; 14:ph14060501. [PMID: 34073977 PMCID: PMC8225154 DOI: 10.3390/ph14060501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/19/2022] Open
Abstract
In this study, we investigated the effect of preservative-free (PF) 0.0015% tafluprost (TA), to the preservative containing (PC) and the PF 0.005% latanoprost (LA) in Korean subjects. This study was conducted as a multi-center, randomized, investigator-blind, active controlled, parallel-group, clinical trial in adult patients (≥19 years) with open-angle glaucoma (OAG) and ocular hypertension (OHT). After a washout period, patients with an IOP between 15 and 35 mmHg were enrolled and evaluated the efficacy, safety, and compliance at 4, 8 and 12 weeks after the first administration. A total of 137 OAG and OHT patients were randomized. Statistically significant reductions in IOP were observed in all groups. Twelve weeks after each eye drop instillation, the mean IOP reduction was −4.59 ± 2.70 mmHg (−24.57 ± 13.49%) in the PC-LA group, −4.52 ± 2.17 mmHg (−24.41 ± 11.38%) in the PF-LA, and −3.14 ± 2.83 mmHg (−17.22 ± 14.57%) in the PF-TA group. The PF-LA showed significantly better responsiveness than did PF-TA. PF-LA was better tolerated than was PC-LA. There were no adverse events that led to cessation of eye drop use in any of the groups. In conclusion, IOP decreased similarly across the groups. PF-LA may provide a good choice for OAG patients with ocular surface diseases.
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22
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Wons J, Mihic N, B Pfister I, Anastasi S, Garweg JG, Halberstadt M. Effect of Preoperative Intraocular Pressure in Patients with and without Intolerance to Their IOP-Lowering Medication on the Outcome of Trabectome Surgery. Clin Ophthalmol 2021; 15:1851-1860. [PMID: 33986587 PMCID: PMC8110264 DOI: 10.2147/opth.s303603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose This study aimed to compare the effect of trabectome surgery in patients with and without intolerance to their medication and with preoperatively sufficiently controlled, insufficiently controlled, and uncontrolled intraocular pressure (IOP) on the surgical outcome. Patients and Methods A total of 155 eyes (133 patients) with different forms of open angle glaucoma with or without intolerance to their glaucoma medication undergoing trabectome surgery alone (AIT) or combined with phacoemulsification (phaco-AIT) were included in this retrospective monocentric study. Patients were corresponding to IOP ≤ 18 mmHg (controlled but glaucoma progression or intolerance, group 1), 19–26 mmHg (insufficiently controlled, group 2), and ≥ 26 mmHg (not controlled, group 3), respectively. Pre- and postoperative IOP and the number of IOP-lowering medications were registered over 12 months. Surgical success was defined as a postoperative IOP of ≤18mmHg and/or reduction of the topical treatment demand after 1 year. Results Of the 155 included eyes, 79 received AIT and 76 received phaco-AIT. Sixty-nine eyes had a preoperatively sufficiently controlled IOP, 63 had an insufficiently controlled IOP, and 23 had an uncontrolled IOP. In all groups, the IOP significantly dropped by 6 and 12 months after surgery (p < 0.001). Surgical success war similar in all groups [47.8% (group 1), 38.1 (group 2) and 34.8% (group 3); p= 0.47]. The effect of AIT on IOP and glaucoma medication independent of intolerance to the anti-glaucoma medication and type of surgery (AIT/phaco-AIT). Conclusion Independently of the preoperative IOP, a satisfying surgical success was achieved using AIT. In instances that do not qualify for filtrating surgery, trabectome surgery alone or in combination with phacoemulsification thus represents a safe and effective minimally invasive glaucoma surgery technique regardless of an intolerance to the topical medication.
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Affiliation(s)
- Juliana Wons
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| | - Nadine Mihic
- Department of Ophthalmology, University of Bern, Bern, Switzerland
| | - Isabel B Pfister
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| | - Stefano Anastasi
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| | - Justus G Garweg
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland.,Department of Ophthalmology, University of Bern, Bern, Switzerland
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23
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Lajmi H, Hmaied W, Achour BB, Zahaf A. Risk Factors for Ocular Surface Disease in Tunisian Users of Preserved Antiglaucomatous Eye Drops. J Curr Ophthalmol 2021; 33:128-135. [PMID: 34409222 PMCID: PMC8365590 DOI: 10.4103/joco.joco_226_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 12/01/2020] [Accepted: 04/01/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To study the clinical and the functional findings in glaucomatous patients under preserved eye drops having ocular surface alterations and to analyze their risk factors. METHODS A cross-sectional study of 155 glaucomatous patients was conducted. All of them answered the "Ocular Surface Disease Index" (OSDI) questionnaire and had a complete and precise evaluation of the ocular surface state including a Schirmer I test, a tear break-up time evaluation, eyelid, conjunctival, and corneal examination with a Fluorescein and a Lissamin green test. We studied factors that could influence the OSDI score and each type of ocular surface alteration (age, sex, glaucoma treatment duration, number and type of the active principle, and Benzalkonium Chloride [BAK] use). RESULTS BAK was used in 80% of cases. The OSDI score was ≥13, in 61.3% of cases. The biomicroscopic signs of ocular surface disease were at least minimal in 87.1% of cases. The main predictors of OSDI score increase were the glaucoma treatment duration (P = 0.01, t = 2.618), the number of molecules used (P = 0.018, t = 2.391), and the use of BAK (P = 0.011, t = 2.58). The severity of the biomicroscopic signs correlated with these same risk factors. Fixed combination was statistically associated with a lower incidence of superficial punctate keratitis (SPK) and corneal and conjunctival staining in the Lissamine green test (P < 0.001). Beta-blockers were associated with a significantly higher risk of SPK and corneal or conjunctival staining in the Lissamine green test (P < 0.001). CONCLUSIONS Preserved antiglaucomatous eye drops alter the patients' ocular surface. The main risk factors were advanced age, duration of glaucoma treatment, multiple therapies, and the use of BAK.
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Affiliation(s)
- Houda Lajmi
- Department of Ophthalmology, Internal Security Forces Hospital, La Marsa, Tunis, Tunisia
| | - Wassim Hmaied
- Department of Ophthalmology, Internal Security Forces Hospital, La Marsa, Tunis, Tunisia
| | - Besma Ben Achour
- Department of Ophthalmology, Internal Security Forces Hospital, La Marsa, Tunis, Tunisia
| | - Amin Zahaf
- Department of Ophthalmology, Internal Security Forces Hospital, La Marsa, Tunis, Tunisia
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24
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Güçlü H, Çınar AK, Çınar AC, Akaray İ, Şambel Aykutlu M, Sakallıoğlu AK, Gürlü V. Corneal epithelium and limbal region alterations due to glaucoma medications evaluated by anterior segment optic coherence tomography: a case-control study. Cutan Ocul Toxicol 2021; 40:85-94. [PMID: 33719786 DOI: 10.1080/15569527.2021.1902341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM To investigate the corneal epithelial and limbal epithelial alterations in patients under topical glaucoma treatment using anterior segment-OCT (AS-OCT) and to determine the changes of the limbal region due to the preservatives and glaucoma drugs, that can progress to limbal stem cell deficiency (LSCD). Limbal thickness was measured by AS-OCT to evaluate limbal cell deficiency. METHODS Forty-seven patients using topical medication for glaucoma, and 48 control subjects were enrolled in this matched case-control study. The patients were divided into four groups according to the treatment regimens. Group 1: One-drug regimen, Group 2: Two-drug regimen, Group 3: Three-drug regimen, Group 4: Four-drug regimen For the ocular surface evaluation; tear break-up time with standard fluorescein sodium sterile strip application, Schirmer test-I, Ocular Surface Disease Index Questionnaire, and AS-OCT were performed. RESULTS A total of 95 subjects were included: 47 eyes of 47 patients with glaucoma medication and 48 eyes of 48 healthy subjects. There was a statistically significant difference between patients and controls according to BUT, SCH, and OSDI (p < 0.001). The mean central corneal epithelium thickness was 48.5 ± 5.3 in patients and 54.5 ± 5.9 in controls (p < 0.001). The mean central total corneal thickness was 529.2 ± 41.2 in patients and 536 ± 35.3 in controls (p = 0.335). The mean limbal epithelium thickness was 64.1 ± 9.1 in patients and 76 ± 11.5 in controls (p < 0.001). CONCLUSION Using at least one glaucoma drug caused limbal area injury, changed ocular surface measurements, and significantly reduced the limbal epithelial thickness where the stem cells reside. The limbal epithelial thickness measurement by AS-OCT seems to be an innovative, non-invasive, and promising technique for detecting and staging corneal damage in topical glaucoma therapy.
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Affiliation(s)
- Hande Güçlü
- Department of Ophthalmology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Ayça Küpeli Çınar
- Department of Ophthalmology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Abdülkadir Can Çınar
- Department of Ophthalmology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - İrfan Akaray
- Department of Ophthalmology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Merve Şambel Aykutlu
- Department of Ophthalmology, Trakya University Faculty of Medicine, Edirne, Turkey
| | | | - Vuslat Gürlü
- Department of Ophthalmology, Trakya University Faculty of Medicine, Edirne, Turkey
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The Effect of Glaucoma on the Quality of Patient’s Life. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2020-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Glaucoma is a chronic, progressive opticopathy with morphological optic disc changes and visual field disturbances. Visual field disturbances change the patient’s life habits. Medical as well as surgical treatments also disturb patients` activities of daily living. According to this, glaucoma is the disease which affects quality of patient’s life (QQL). Visual field (VF) evaluation is very important in glaucoma disease diagnostic process. Location of the VF defects also have an impact on the QOL. Patient`s daily activities, such as walking, low light condition adaptation, peripheral seeing of the objects, can be affected by glaucoma progression and with VF defects. All social, religious, cultural and traveling events are more difficult for the severe glaucomatous patients (MD<-12dB) in comparison with mild glaucomatous, defined as patients with MD > −6 dB. Every day usage of the local antuglaucomatous therapy disturbs patients’ QOL. The side effects of the eye drops can produce burning sensation, bronchospasm, bradycardia, increased iris pigmentation, increased eyelash length. Also, locally applied therapy provokes ocular surface disease. Benzalkonium chloride provokes destruction of the epithelial cells junction with development of the epitheliopathy and ocular surface disease. Surgically treated glaucoma patients can have disturbed QOL due to ocular surface disease symptoms (foreign body sensation, eye pain, redness, and increased tearing). These symptoms are caused by trabeculectomy and they are correlated with filtering bleb existence.To achieve QOL of the glaucomatous patients, different founded instruments are used. They are classified in: general health, vision specific, and glaucoma specific.
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Erb C, Stalmans I, Iliev M, Muñoz-Negrete FJ. Real-World Study on Patient Satisfaction and Tolerability After Switching to Preservative-Free Latanoprost. Clin Ophthalmol 2021; 15:931-938. [PMID: 33688161 PMCID: PMC7936704 DOI: 10.2147/opth.s295821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/12/2021] [Indexed: 01/09/2023] Open
Abstract
Purpose Patient satisfaction is important in the treatment of glaucoma. Suboptimal compliance and impaired long-term outcome are a likely result of poor tolerability. The present multicentre, international, transverse, epidemiological survey was conducted to assess the satisfaction of patients who had received preservative-free latanoprost (PFL) for at least 3 months. Patients and Methods A total of 1872 patients from 6 European countries, treated with PFL for at least 3 months, were included in this survey. Prior to PFL treatment, patients were to be treatment naïve or currently treated for their glaucoma. During a single routine consultation, patients completed a questionnaire concerning global satisfaction and satisfaction based on tolerability. Results In total, 76.2% had been previously treated; 69.4% had received preserved and 6.8% preservative-free (PF) topical treatment. After 3 months of PFL treatment, a large majority of patients (95.3%) were satisfied or very satisfied with their PFL treatment and were, overall, significantly (p<0.0001) more satisfied with PFL than with their previous treatment; 4.2% were either unsatisfied or very unsatisfied. Overall, 97.3% of originally treatment-naïve patients were satisfied (50.1%) or very satisfied (47.2%) with their PFL. Ocular surface disease was diagnosed in 9.2% of patients (n=173) and was mainly mild (76.9%). Patient satisfaction with PFL was very high. Conclusion PFL may be considered a valuable first-choice treatment in glaucoma patients.
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Affiliation(s)
- Carl Erb
- Eye Clinic Wittenbergplatz, Berlin, Germany
| | - Ingeborg Stalmans
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Milko Iliev
- Ophthalmology Department, University of Bern, Inselspital, Bern, Switzerland
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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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Su CC, Lee YC, Lee PRC. Assessment of ocular surface disease in glaucoma patients with benzalkonium chloride-preserved latanoprost eye drops: a short-term longitudinal study. Graefes Arch Clin Exp Ophthalmol 2021; 259:1243-1251. [PMID: 33433642 DOI: 10.1007/s00417-020-05067-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/15/2020] [Accepted: 12/28/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To prospectively evaluate the effect of benzalkonium chloride (BAK)-preserved latanoprost on ocular surface damage and identify the associated risk factors among treatment-naive glaucoma patients. METHODS The basal Schirmer's test results, corneal Oxford staining score, non-invasive keratograph tear-breakup time, oculus hyperemia index score (objective metrics), and ocular surface disease index (OSDI) questionnaire (subjective metric) were evaluated at baseline, 1 month, and 4 months after receiving latanoprost eye drops. Associated risk factors were assessed by multivariate linear regression. RESULTS Seventy-four eyes (44 patients) were enrolled. Basal Schirmer's test tear-flow and Oxford scores gradually deteriorated (β = -0.14, P = 0.001 and β = 0.1, P < 0.001, respectively). The percentage of unstable tear-film (breakup time < 10 s) increased significantly at 4 months (6.21% vs 9.11%, P = 0.042). Hyperemic scores increased significantly at 1 month and normalized at 4 months (P = 0.01 and P = 0.16, respectively); total OSDI scores tended to improve (β = -0.76, P = 0.06). Older age was associated with additional corneal Oxford staining (P = 0.005); female sex was associated with increased unstable tear-film scores (P = 0.01). Artificial tear use was associated with a smaller decrease in basal Schirmer's test values (P = 0.01) and a smaller increase in unstable tear-film scores (P = 0.02). CONCLUSIONS Preserved latanoprost eye drops affected ocular surface changes in glaucoma patients through decreased basal tear secretion. Artificial tears represent an early intervention in vulnerable glaucoma patients with reduced tear secretion and impaired tear-film stability.
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Affiliation(s)
- Chien-Chia Su
- Department of Ophthalmology, National Taiwan University Hospital College of Medicine, National Taiwan University, No. 7, Chung-Shan S. Rd, Taipei, Taiwan. .,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan. .,National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Yi-Chieh Lee
- Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Peter Richmond Candano Lee
- Department of Ophthalmology, National Taiwan University Hospital College of Medicine, National Taiwan University, No. 7, Chung-Shan S. Rd, Taipei, Taiwan
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So HR, Park HYL, Chung SH, Kim HS, Byun YS. Effect of Autologous Serum Eyedrops on Ocular Surface Disease Caused by Preserved Glaucoma Eyedrops. J Clin Med 2020; 9:jcm9123904. [PMID: 33271908 PMCID: PMC7761382 DOI: 10.3390/jcm9123904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022] Open
Abstract
Autologous serum eyedrops (ASE) are effective in treating various ocular surface diseases, including damages induced by long-term use of preserved glaucoma eyedrops. However, there has been no study on whether ASE is effective without stopping the causative eyedrops. This retrospective observational study included 55 patients with ocular-surface diseases caused by long-term use of preserved glaucoma eyedrops: 18 patients who used ASEs for 2 months without discontinuing the use of glaucoma eyedrops (Group 1), 22 patients who used ASEs for 2 months, discontinuing the use of glaucoma eyedrops for the first month (Group 2) and 15 patients who used non-preservative artificial tears for 2 months, discontinuing the use of glaucoma eyedrops for the first month (Group 3). There were no intergroup differences in the baseline values of the Schirmer I test results, tear breakup time (TBUT), ocular surface staining (OSS) score, loss of the meibomian gland, meibum quality and ocular-surface disease index (OSDI). Group 1 showed significant differences in TBUT, OSS score and OSDI at 2 months when compared to the baseline values before treatment, while Group 2 showed significant differences in those values at both 1 and 2 months. There were no differences in any of the parameters at baseline, 1 month or 2 months in Group 3. Our result suggested that ASE is effective for treating ocular surface diseases caused by glaucoma eyedrops containing preservatives and its effects can be expected without interruption of glaucoma eyedrop treatment.
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Evaluation of ocular surface disease in elderly patients with glaucoma: expression of matrix metalloproteinase-9 in tears. Eye (Lond) 2020; 35:892-900. [PMID: 32472047 DOI: 10.1038/s41433-020-0993-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the symptoms and signs of ocular surface disease (OSD) and tear-film matrix metalloproteinase-9 (MMP-9) overexpression using point-of-care testing (InflammaDry test) in patients with primary open-angle glaucoma (POAG). METHODS This prospective, case-control study included 67 patients diagnosed with POAG and 47 healthy control subjects. The OSD assessment included Schirmer-I test, the Oxford corneal stain scale, tear breakup time (TBUT), and the five-item dry eye questionnaire (DEQ-5). Measurement of extracellular MMP-9 level was performed using the InflammaDry test. The OSD parameters and MMP-9 expression levels were compared between the POAG group and the control group. Additional subgroup analysis in POAG group was performed according to number of topical glaucoma medications (Bottle 1, 2, or 3 medications). RESULTS There were significant differences between the control and POAG groups for all OSD parameters. MMP-9 overexpression was observed in 71.6% of POAG group, whereas only 31.9% of control group showed MMP-9 overexpression. The subgroup analysis revealed that DEQ-5, Oxford stain score, Schirmer-I, and MMP-9 overexpression demonstrated no significant difference among the three groups. Abnormal TBUT (≤5 s) was observed in 37.5%, 59.1%, and 76.2% for each subgroup according to number of bottles (1, 2, and 3), and strong MMP-9 overexpression were also detected in 25.0%, 40.9%, and 61.9%, respectively (P = 0.032, P = 0.043). CONCLUSIONS The use of preservative-containing medications may affect the ocular surface in patients with POAG. Graded measurement of tear-film MMP-9 could provide more information on OSD and might be a more useful marker for inflammation than then conventional results obtained by using an MMP-9 kit.
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Fu L, Chan YK, Li J, Nie L, Li N, Pan W. Long term outcomes of cataract surgery in severe and end stage primary angle closure glaucoma with controlled IOP: a retrospective study. BMC Ophthalmol 2020; 20:160. [PMID: 32306921 PMCID: PMC7168992 DOI: 10.1186/s12886-020-01434-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/13/2020] [Indexed: 11/18/2022] Open
Abstract
Background To investigate the long term surgical outcomes of cataract surgery in severe and end stage glaucoma patients with preoperative intraocular pressure less than 21 mmHg, and to detect the associated factors. Methods A retrospective study of primary angle closure glaucoma patients was conducted on who underwent cataract surgery or combined with goniosynechialysis from March 2015 to April 2018. Main outcome measures were visual acuity, intraocular pressure, number of glaucoma medications and complications. Results Sixteen patients (19 eyes) were included. The mean age was 64.89 ± 11.68 years and the mean followed up duration was 21.89 ± 7.85 months. The final visual acuity was significantly improved from 0.69 ± 0.55 to 0.46 ± 0.52 logMAR, within 12 (63.2%) eyes improved, 4 (21.1%) eyes kept unchanged, and 3 (15.8%) eyes reduced. Linear regression analysis indicated that higher mean deviation, higher visual field index and lower glaucoma stage associated with better final visual acuity (r = − 0.511, r = − 0.493, r = 0.537 respectively). Moreover, the final number of medications were reduced from 1.26 ± 0.99 to 0.26 ± 0.56 (p < 0.01). The mean intraocular pressure was not significantly reduced with the final IOP of 14.48 ± 3.74 mmHg (p = 0.97). While the eyes with intraocular pressure above 15 mmHg was decreased to 6 (31.6%) eyes compared to 10 (52.6%) eyes at baseline. Moreover, the number of eyes free of medications was increased from 4 (21.1%) preoperatively to 15 (78.9%) eyes postoperatively. Conclusions Final visual acuity was significantly improved in the severe and end stage primary angle closure glaucoma patients and the number of eyes came off medications increased by 57.8% after cataract surgery. Preoperatively, the glaucoma stage, mean deviation and visual field index are important parameters to predict the final visual acuity after cataract surgery.
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Affiliation(s)
- Lin Fu
- Department of Glaucoma, Affiliated Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, 618# Feng Qi Dong Road, Hangzhou, Zhejiang Province, 325000, People's Republic of China
| | - Yau Kei Chan
- Department of Ophthalmology, LKS Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Junhua Li
- Department of Glaucoma, Affiliated Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, 618# Feng Qi Dong Road, Hangzhou, Zhejiang Province, 325000, People's Republic of China
| | - Li Nie
- Department of Glaucoma, Affiliated Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, 618# Feng Qi Dong Road, Hangzhou, Zhejiang Province, 325000, People's Republic of China
| | - Na Li
- Department of Glaucoma, Affiliated Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, 618# Feng Qi Dong Road, Hangzhou, Zhejiang Province, 325000, People's Republic of China
| | - Weihua Pan
- Department of Glaucoma, Affiliated Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, 618# Feng Qi Dong Road, Hangzhou, Zhejiang Province, 325000, People's Republic of China.
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Guarnieri A, Carnero E, Bleau AM, López de Aguileta Castaño N, Llorente Ortega M, Moreno-Montañés J. Ocular surface analysis and automatic non-invasive assessment of tear film breakup location, extension and progression in patients with glaucoma. BMC Ophthalmol 2020; 20:12. [PMID: 31906897 PMCID: PMC6945571 DOI: 10.1186/s12886-019-1279-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 12/20/2019] [Indexed: 01/15/2023] Open
Abstract
Background Tear film stability is the key event in ocular surface diseases. The purpose of this study is to evaluate spatial and temporal progression of the tear film breakup using an automatic non-invasive device. Methods Non-invasive tear breakup time (NITBUT) parameters, such as First NITBUT (F-NITBUT) and Average NITBUT (A-NITBUT), were evaluated in 132 glaucoma and 87 control eyes with the Keratograph 5 M device. Further analysis of this data was used to determine size, location and progression of tear film breakup with automatically identified breakup areas (BUA). The progression from First BUA (F-BUA) to total BUA (T-BUA) was expressed as Dry Area Growth Rate (DAGR). Differences between both groups were analysed using Student t-test for parametric data and Mann-Whitney U test for non-parametric data. Pearson’s correlation coefficient was used to assess the relationship between parametric variables and Spearman in the case of non-parametric variables. Results F-NITBUT was 11.43 ± 7.83 s in the control group and 8.17 ± 5.73 in the glaucoma group (P = 0.010). A-NITBUT was 14.04 ± 7.21 and 11.82 ± 6.09 s in control and glaucoma groups, respectively (P = 0.028). F-BUA was higher in the glaucoma group than in the control group (2.73 and 2.28; P = 0.022) and was more frequently located at the centre of the cornea in the glaucoma group (P = 0.039). T-BUA was also higher in the glaucoma group than in the control group (13.24 and 9.76%; P = 0.012) and the DAGR was steeper in the glaucoma group than in the control group (34.38° and 27.15°; P = 0.009). Conclusions Shorter NITBUT values and bigger, more central tear film breakup locations were observed in the glaucoma group than in the control group. The DAGR indicates that tear film rupture is bigger and increases faster in glaucomatous eyes than in normal eyes.
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Affiliation(s)
- Adriano Guarnieri
- Department of Ophthalmology, Universidad de Navarra, Pamplona, Spain.
| | - Elena Carnero
- Department of Ophthalmology, Universidad de Navarra, Pamplona, Spain
| | - Anne-Marie Bleau
- Department of Ophthalmology, Universidad de Navarra, Pamplona, Spain
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Chau SF, Wu PH, Sun CC, Huang JY, Nien CW, Yang SF, Chou MC, Lu PT, Chen HC, Lee CY. The Development of Glaucoma after Surgery-Indicated Chronic Rhinosinusitis: A Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224456. [PMID: 31766214 PMCID: PMC6887744 DOI: 10.3390/ijerph16224456] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 11/16/2022]
Abstract
This study investigates the development of glaucoma in subjects with surgery-indicated chronic rhinosinusitis (CRS) by the use of the National Health Insurance Research Database in Taiwan. Individuals that received the functional endoscopic sinus surgery (FESS) with a diagnostic code of CRS were regarded as surgery-indicated CRS and enrolled in the study group. Four non-CRS patients were age- and gender-matched to each patient in the study group. The exclusion criteria included legal blindness, ocular tumor, history of eyeball removal, and previous glaucoma. The outcome was regarded as the development of glaucoma, and conditional logistic regression was used for the statistical analysis, which involved multiple potential risk factors in the multivariate model. A total of 6506 patients with surgery-indicated CRS that received FESS and another 26,024 non-CRS individuals were enrolled after exclusion. The age and gender distributions were identical between the two groups due to matching. There were 108 and 294 glaucoma events in the study group and control group, respectively, during the follow-up period, and the study group had a significantly higher adjusted hazard ratio (1.291, 95% confidential interval: 1.031–1.615). The cumulative probability analysis also revealed a correlation between the occurrence of glaucoma and the CRS disease interval. In the subgroup analysis, the chance of developing open-angle glaucoma and normal-tension glaucoma was significantly higher in the study group than in the control group. In conclusion, the existence of surgery-indicated CRS is a significant risk factor for the development of glaucoma, which correlated with the disease interval.
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Affiliation(s)
- Siu-Fung Chau
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (S.-F.C.); (C.-W.N.); (S.-F.Y.); (M.-C.C.)
- Department of Ophthalmology, Taichung Tzu Chi Hospital, Taichung 40201, Taiwan
| | - Pei-Hsuan Wu
- Department of Otolaryngology–Head and Neck Surgery, Tri-Service General Hospital, Taipei 11221, Taiwan;
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 20402, Taiwan; (C.-C.S.); (P.-T.L.)
- Department of Chinese Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
| | - Chan-Wei Nien
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (S.-F.C.); (C.-W.N.); (S.-F.Y.); (M.-C.C.)
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua 50093, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (S.-F.C.); (C.-W.N.); (S.-F.Y.); (M.-C.C.)
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
| | - Ming-Chih Chou
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (S.-F.C.); (C.-W.N.); (S.-F.Y.); (M.-C.C.)
| | - Pei-Ting Lu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 20402, Taiwan; (C.-C.S.); (P.-T.L.)
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou 33305, Taiwan
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou 33305, Taiwan
- Correspondence: (H.-C.C.); (C.-Y.L.)
| | - Chia-Yi Lee
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua 50093, Taiwan
- Department of Optometry, College of Medicine and Life Science, Chung Hwa University of Medical Technology, Tainan 717, Taiwan
- Correspondence: (H.-C.C.); (C.-Y.L.)
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Yoon CH, Lee HJ, Park HY, Kim H, Kim MK, Jeoung JW, Oh JY. Effects of topical autologous serum on the ocular surface in patients with toxic corneal epitheliopathy induced by anti-glaucoma drugs. Int Ophthalmol 2019; 40:547-552. [PMID: 31705358 DOI: 10.1007/s10792-019-01211-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/28/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE To investigate the effects of topical autologous serum application on the ocular surface in patients with toxic corneal epitheliopathy induced by anti-glaucoma drugs. METHODS The patients who had corneal epitheliopathy because of preservative-containing anti-glaucoma eye drops were prospectively enrolled. The epitheliopathy was refractory to preservative-free artificial tear treatment. The patients topically applied 20% autologous serum to the eye eight times per day for 1 month. Baseline and one-month change in symptoms and signs were assessed by the Ocular Surface Disease Index (OSDI) questionnaire, tear film break-up time (TFBUT), Schirmer I values, corneoconjunctival staining scores, corneal sensitivity, InflammaDry® tear immunoassay, and tear cytokine profiles using a bead-based multiplex assay. RESULTS A total of ten consecutive patients were enrolled between January and August 2018 and evaluated after one-month treatment with 20% autologous serum eye drops. Significant improvement was observed in symptoms (OSDI scores from 25.5 ± 20.9 to 10.5 ± 12.0; P = .039), TFBUT (from 3.1 ± 1.8 s to 5.4 ± 2.3 s; P = .025), corneoconjunctival staining scores (from 7.7 ± 1.8 to 1.8 ± 1.9 NEI scale; P = .005), corneal sensitivity (from 4.6 ± .9 cm to 5.8 ± .5 cm; P = .013), and metalloproteinase-9 levels (P = .013). There were no significant changes in Schirmer I values and tear cytokine levels on multiplex assays. Treatment-related side effects were not detected. CONCLUSIONS Topical instillation of 20% autologous serum is an effective treatment for toxic corneal epitheliopathy associated with anti-glaucoma eye drops. TRIAL REGISTRATION NUMBER KCT0003827.
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Affiliation(s)
- Chang Ho Yoon
- Department of Ophthalmology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyun Ju Lee
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hye Youn Park
- Tissue Bank, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyungsuk Kim
- Department of Laboratory Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Joo Youn Oh
- Department of Ophthalmology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Roberti G, Tanga L, Manni G, Riva I, Verticchio AC, Berardo F, Carnevale C, Oddone F. Tear Film, Conjunctival and Corneal Modifications Induced by Glaucoma Treatment. Curr Med Chem 2019; 26:4253-4261. [PMID: 31099319 DOI: 10.2174/0929867326666190517111823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/18/2019] [Accepted: 03/29/2019] [Indexed: 11/22/2022]
Abstract
Ocular surface disease is characterized by tear film instability and histopathologic and clinical changes of the ocular surface. Glaucoma patients often suffer from ocular surface disease caused by the chronic use of preserved medical treatment to reduce intraocular pressure. Benzalkonium chloride is the preservative most frequently used in glaucoma medications. Its effect on tear film, conjunctiva and cornea and the consequences in glaucoma management are discussed in this mini-review.
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Affiliation(s)
| | | | - Gianluca Manni
- IRCCS-Fondazione Bietti, Rome, Italy.,DSCMT University of Rome Tor Vergata, Via Orazio Raimondo 18, 00173, Rome, Italy
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García-Porta N, Gantes-Nuñez FJ, Tabernero J, Pardhan S. Characterization of the ocular surface temperature dynamics in glaucoma subjects using long-wave infrared thermal imaging. JOURNAL OF THE OPTICAL SOCIETY OF AMERICA. A, OPTICS, IMAGE SCIENCE, AND VISION 2019; 36:1015-1021. [PMID: 31158132 DOI: 10.1364/josaa.36.001015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/23/2019] [Indexed: 06/09/2023]
Abstract
We evaluated the dynamics of ocular surface temperature using thermal imaging in 21 glaucoma subjects and 19 healthy subjects. On opening of the eye, subjects with glaucoma showed significantly cooler temperatures in the central cornea compared to the control group. The upper eyelid was also significantly cooler just before the eye opened. Immediately after opening the eye, the dynamic of temperature change was different in the two groups. In subjects with glaucoma, the eyes cooled significantly faster, with an average decrease of 0.49°C during the first second compared to 0.24°C in the control group. Our results support the hypothesis that both the stability of the tear film and changes in the ocular blood supply in subjects with glaucoma play an important role in thermal dynamics of the ocular surface.
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El Ameen A, Vandermeer G, Khanna RK, Pisella PJ. Objective ocular surface tolerance in patients with glaucoma treated with topical preserved or unpreserved prostaglandin analogues. Eur J Ophthalmol 2018; 29:645-653. [DOI: 10.1177/1120672118805877] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Preservatives in glaucoma medications have been associated with ocular toxicity. We compared ocular signs and symptoms in patients with open-angle glaucoma or ocular hypertension treated in monotherapy with preserved or preservative-free prostaglandin analogues. Methods: Observational cross-sectional clinical study in real life. 82 patients treated for at least 6 months with prostaglandin analogue were assessed for intraocular pressure, ocular symptoms and ocular signs including conjunctival hyperaemia, tear break-up time and tear meniscus height measured using objective and non-invasive methods (OCULUS Keratograph 5M). Patients presenting with symptoms of ocular toxicity with preserved prostaglandin analogues were switched to preservative-free latanoprost, and a second assessment was processed 6 months after. Results: At inclusion, 30 (36.6%) patients were treated with preservative-free latanoprost, 25 (30.5%) with preserved latanoprost, 16 (19.5%) with preserved travoprost and 11 (13.4%) with preserved bimatoprost. Patients treated with preservative-free latanoprost reported significantly less ocular symptoms upon instillation (mainly burning) and between instillations than patients treated with preserved prostaglandin analogues. The mean conjunctival hyperaemia (limbal + bulbar) was significantly lower with preservative-free latanoprost (2.08 ± 0.55) compared to preserved latanoprost (2.50 ± 0.7, p = 0.0085), preserved travoprost (2.67 ± 0.82, p = 0.0083) and preserved bimatoprost (2.68 ± 0.67, p = 0.0041). There were no relevant between-group differences in mean tear meniscus height and break-up time. Ocular symptoms and conjunctival hyperaemia improved when preserved prostaglandin analogues were switched to preservative-free latanoprost for 6 months while intraocular pressure reduction was maintained. Conclusion: Overall, this study suggests a better subjective and objective ocular tolerance when patients were treated with preservative-free latanoprost than with other preserved prostaglandin analogues monotherapy. Switching to preservative-free latanoprost maintained intraocular pressure at the same level as preservative prostaglandin analogue, but improved ocular surface tolerance.
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Affiliation(s)
- Ammar El Ameen
- Ophthalmology Department, CHRU Bretonneau, University of Tours, Tours, France
| | | | - Raoul K Khanna
- Ophthalmology Department, CHRU Bretonneau, University of Tours, Tours, France
| | - Pierre-Jean Pisella
- Ophthalmology Department, CHRU Bretonneau, University of Tours, Tours, France
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Effects of 20% Human Serum on Corneal Epithelial Toxicity Induced by Benzalkonium Chloride: In Vitro and Clinical Studies. Cornea 2018; 37:617-623. [PMID: 29300263 DOI: 10.1097/ico.0000000000001475] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Benzalkonium chloride (BAK), the most commonly used preservative in ophthalmic solutions, is known to cause toxicity in the corneal epithelium. In this study, we investigated the effects of 20% human serum in cultures of BAK-damaged human corneal epithelial cells (hCECs) and in patients with toxic corneal epitheliopathy induced by BAK-containing eye drops. METHODS hCECs were exposed to various concentrations of BAK (0%, 0.002%, 0.02%, and 0.2%) in the presence or absence of 20% human serum. After 24 hours, the metabolic activity, proliferation, apoptosis, and proinflammatory cytokine expression were evaluated in the cells. Also, cell migration was assessed using a scratch test. In the clinical study, 24 patients with toxic corneal epitheliopathy secondary to BAK-containing antiglaucoma eye drops were treated with topical application of 20% autologous serum, and corneal epithelial integrity was evaluated. RESULTS BAK induced cytotoxicity in hCECs by inhibiting the metabolic activity, proliferation, and migration and by increasing apoptosis in a concentration-dependent manner. The level of proinflammatory cytokine IL-8 was elevated in BAK-treated cells. Addition of 20% human serum to the cultures significantly promoted the cell metabolic activity, proliferation, and migration while markedly reducing apoptosis. In line with the in vitro results, corneal punctate epithelial erosions were decreased from a National Eye Institute scale score of 4.2 ± 2.1 to 1.3 ± 1.7 in 20 of 24 patients (84%) after treatment with 20% autologous serum. CONCLUSIONS Data demonstrate that 20% human serum is effective in treating BAK-induced cytotoxicity in hCECs and provides a basis for using 20% autologous serum for patients with preservative-induced corneal epitheliopathy.
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Pérez Bartolomé F, Martínez de la Casa JM, Arriola Villalobos P, Fernández Pérez C, Polo V, Sánchez Jean R, García Feijoó J. Ocular Redness Measured with the Keratograph 5M in Patients Using Anti-Glaucoma Eye Drops. Semin Ophthalmol 2017; 33:643-650. [PMID: 29144869 DOI: 10.1080/08820538.2017.1395891] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To examine correlations between ocular redness measured with the new topographer Keratograph 5M and the use of topical anti-glaucoma medication. METHODS A total of 211 eyes of 211 patients with open-angle glaucoma or ocular hypertension on topical medication and 51 eyes of 51 healthy volunteers were recruited over 10 months. Outcome variables were keratograph redness scores (RS): overall, bulbar temporal (BT), bulbar nasal (BN), limbar temporal (LT), and limbar nasal (LN). In each subject, we also recorded the intraocular pressure-lowering eye drops used, daily doses and daily and cumulative preservative concentrations, fluorescein corneal staining score (OXFORD), lower tear meniscus height (Fourier-domain OCT), non-invasive tear film breakup time (Keratograph 5M), and ocular surface disease questionnaire index (OSDI). RESULTS Higher RS were recorded in the medication than control group (P < 0.01 all scores). Within the medication group, older patients returned greater RS (P < 0.05 all scores). Prostaglandin was a strong predictor of higher scores, except LN RS. A higher OSDI was associated with a higher LN RS (β = 0.007; P < 0.05), while the use of β-blockers was linked to a lower LN RS (β = -0.225; P < 0.05). The use of ≥3 daily eye drops with preservative gave rise to a higher BN RS and ≥3 daily eye drops to a higher LN RS (β = 0.366, P < 0.01; β = 0.296, P < 0.05, respectively). CONCLUSION Keratograph 5M can objectively detect the hyperaemia induced by glaucoma medication. The factors contributing to ocular redness were advanced age, more daily eye drops (nasal sectors), a higher OSDI, and prostaglandin as the medication used.
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Affiliation(s)
- Francisco Pérez Bartolomé
- a Ophthalmology, Hospital Clínico San Carlos , Instituto de Investigación Sanitaria San Carlos (IdISSC) , Madrid , Spain.,b Ramon Castroviejo Institute , Universidad Complutense , Madrid , Spain
| | - Jose María Martínez de la Casa
- a Ophthalmology, Hospital Clínico San Carlos , Instituto de Investigación Sanitaria San Carlos (IdISSC) , Madrid , Spain.,b Ramon Castroviejo Institute , Universidad Complutense , Madrid , Spain
| | - Pedro Arriola Villalobos
- a Ophthalmology, Hospital Clínico San Carlos , Instituto de Investigación Sanitaria San Carlos (IdISSC) , Madrid , Spain.,b Ramon Castroviejo Institute , Universidad Complutense , Madrid , Spain
| | - Cristina Fernández Pérez
- c Department of Epidemiology and Preventive Medicine, Hospital Clínico San Carlos , Universidad Complutense , Madrid , Spain
| | - Vicente Polo
- d Department of Ophthalmology , Hospital Miguel Servet , Zaragoza , Spain
| | - Ruben Sánchez Jean
- a Ophthalmology, Hospital Clínico San Carlos , Instituto de Investigación Sanitaria San Carlos (IdISSC) , Madrid , Spain.,b Ramon Castroviejo Institute , Universidad Complutense , Madrid , Spain
| | - Julián García Feijoó
- a Ophthalmology, Hospital Clínico San Carlos , Instituto de Investigación Sanitaria San Carlos (IdISSC) , Madrid , Spain.,b Ramon Castroviejo Institute , Universidad Complutense , Madrid , Spain
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