An In Vivo Confocal Microscopy Analysis of Effects of Topical Antiglaucoma Therapy With Preservative on Corneal Innervation and Morphology

Martone, Gianluca; Frezzotti, Paolo; Tosi, Gian Marco; Traversi, Claudio; Mittica, V.; Malandrini, Alex; Pichierri, Patrizia; Balestrazzi, Angelo; Motolese, Paolo Alfonso; Motolese, Ilaria; Motolese, Edoardo

doi:10.1016/j.ajo.2008.10.019

Cited by 196 publications

(222 citation statements)

References 43 publications

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“…24,25 The effects of glaucoma medications on corneal endothelium, keratocytes, and sub-basal nerves among participants in the OHT treatment study revealed that chronic topical hypotensive therapy resulted in a decrease in the number and density of corneal sub-basal nerve fiber bundles but did not affect the keratocyte density or corneal endothelial characteristics. 14 Another retrospective study 5 on the long-term effects of preservative-free and preservativecontaining antiglaucoma eye drops on the tear secretion and ocular surface had divided their study participants into five groups according to the type of topical hypotensive therapy and found that glaucomatous patients with chronic treatment show ocular surface alterations. The described confocal microscopy changes include significant decrease in density of superficial epithelial cells, higher density of basal epithelial cells, activated stromal keratocytes, higher beading of the nerves, lower number of sub-basal nerves and higher SBNFL tortuosity in those with ocular hypotensive medications with preservatives.…”

Section: Discussionmentioning

confidence: 99%

“…A complex relationship seems to exist between the ocular surface changes, DED and decreased SBNFL in these eyes on chronic antiglaucoma medical treatment. 5 Sensitization of ocular surface nerves and disruption of corneal barrier function occurs in chronic ocular surface inflammation due to DED leading to nerve degeneration and altered SBNFL characteristics. 6 Studies show that topical administration of CsA 0.05% significantly increases tear production, decreases ocular surface damage and dry eye symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…6 Several adverse effects on ocular surface and corneal innervation has been reported in patients on long-term antiglaucoma medications. 5 The role of in vivo confocal microscopy in ocular surface analysis of dry eye and glaucomatous patients has been elucidated. 5,[7][8][9][10][11][12][13][14] Topical cyclosporine has been proven to have a beneficial effect in cases of dry eye disease (DED).…”

Section: Introductionmentioning

confidence: 99%

“…5 The role of in vivo confocal microscopy in ocular surface analysis of dry eye and glaucomatous patients has been elucidated. 5,[7][8][9][10][11][12][13][14] Topical cyclosporine has been proven to have a beneficial effect in cases of dry eye disease (DED). 15 In a recent study in rabbit eyes beneficial effects of topical cyclosporine has been demonstrated on adverse ocular surface changes produced by long-term antiglaucoma medications.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 The epithelial cells, in reciprocation, produce the soluble factors neuronal growth factor and glial cell-derived neurotrophic factor with a neurotrophic effect. 5 Chronic ocular surface inflammation sensitizes ocular surface nerves and can also disrupt corneal barrier function. Nerve degeneration that occurs in the scenario of chronic ocular surface inflammation, as in cases of dry eye, may lead to altered sub-basal nerve fiber morphology in eyes.…”

Section: Introductionmentioning

confidence: 99%

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Topical cyclosporine to control ocular surface disease in patients with chronic glaucoma after long-term usage of topical ocular hypotensive medications

Saini

Dhiman

Dada

et al. 2015

Eye

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Purpose To evaluate changes in ocular surface and central corneal sub-basal nerve fiber layer (SBNFL) after topical cyclosporin therapy in chronic glaucoma patients on long-term topical antiglaucoma therapy. Methods A prospective comparative study of ocular surface evaluation of chronic glaucoma patients on long-term topical therapy treated concurrently with a topical cyclosporine 0.05% twice daily for 6 months and controls was done. The study parameters evaluated at recruitment and at the 6-month follow-up included details of topical antiglaucoma medications, visual acuity, intraocular pressure, ocular surface evaluation parameters (TBUT, Schirmers I, ocular surface staining scores and ocular surface disease (OSD) index score (OSDI)), central corneal sensation (Cochet Bonnett aesthesiometer), and central confocal microscopy to study the SBNFL density (SBNFLD). Results Thirty-two eyes of 16 patients with chronic glaucoma and 30 eyes of 15 normal subjects as controls were studied. Mean TBUT, pre/post CsA treatment was 8.67 ± 3.01/12.24 ± 1.83 s (P = 0.007). Mean conjunctival/corneal staining scores pre/post CsA treatment were 3.38 ± 1.93/1.50 ± 0.718 (P = 0.00) /5.19 ± 1.82/1.81 ± 0.78 (P = 0.098), respectively. Mean OSDI pre/post CsA treatment scores were 30.63 ± 14.61/14.76 ± 6.06 (P = 0.007). Mean corneal sensations scores pre/post CsA treatment were 4.64 ± 0.46/4.94 ± 0.39 (P = 0.002). Central corneal SBNFLD pre and post CsA treatment was 8811.35 ± 2985.29/10335.13 ± 4092.064 μm/mm 2 (P = 0.0001).Conclusions Schirmer's test, ocular surface staining scores, OSDI, corneal sensations, and corneal SBNFLD showed a statistically significant improvement following a 6-month concurrent topical CsA therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Topical cyclosporine to control ocular surface disease in patients with chronic glaucoma after long-term usage of topical ocular hypotensive medications

Saini

Dhiman

Dada

et al. 2015

Eye

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Corneal epithelial cells function as surrogate Schwann cells for their sensory nerves

Stepp

Tadvalkar

Hakh

et al. 2016

Glia

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The eye is innervated by neurons derived from both the central nervous system and peripheral nervous system. While much is known about retinal neurobiology and phototransduction, less attention has been paid to the innervation of the eye by the PNS and the roles it plays in maintaining a functioning visual system. The ophthalmic branch of the trigeminal ganglion contains somas of neurons that innervate the cornea. These nerves provide sensory functions for the cornea and are referred to as intraepithelial corneal nerves (ICNs) consisting of subbasal nerves and their associated intraepithelial nerve terminals. ICNs project for several millimeters within the corneal epithelium without Schwann cell support. Here, we present evidence for the hypothesis that corneal epithelial cells function as glial cells to support the ICNs. Much of the data supporting this hypothesis is derived from studies of corneal development and the reinnervation of the ICNs in the rodent and rabbit cornea after superficial wounds. Corneal epithelial cells activate in response to injury via mechanisms similar to those induced in Schwann cells during Wallarian Degeneration. Corneal epithelial cells phagocytize distal axon fragments within hours of ICN crush wounds. During aging, the proteins, lipids, and mitochondria within the ICNs become damaged in a process exacerbated by UV light. We propose that ICNs shed their aged and damaged termini and continuously elongate to maintain their density. Available evidence points to new unexpected roles for corneal epithelial cells functioning as surrogate Schwann cells for the ICNs during homeostasis and in response to injury.

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Evaluation of corneal epithelial thickness in glaucomatous patients using anterior‐segment optical coherence tomography

Montorio

Cennamo

Breve

et al. 2019

Journal of Biophotonics

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The corneal epithelium represents one of the main structures that undergo degenerative alterations due to antiglaucomatous therapy. Chronic glaucoma therapy containing benzalkonium chloride induces epithelial cellular changes and inflammatory infiltration that in turn causes ocular surface changes resulting in ocular discomfort. Also, age‐related changes can involve the tear film stability and the corneal epithelium surface with reduction of microvilli. The objective of this study is to gain insights about the changes in corneal epithelium in glaucomatous patients divided according to age, type and duration of therapy using anterior‐segment optical coherence tomography (AS‐OCT). This study evaluated a total of 81 eyes of 42 patients for whom corneal epithelium thickness (CET) was measured in different sectors of the cornea. Our results showed no significant differences in CET among patients divided according to type and duration of treatment, while younger patients showed a thinner CET in comparison with older patients. AS‐OCT results demonstrated that the physiological age‐related alterations contributed to corneal epithelium changes in patients undergo chronic antiglaucoma therapy.

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An In Vivo Confocal Microscopy Analysis of Effects of Topical Antiglaucoma Therapy With Preservative on Corneal Innervation and Morphology

Cited by 196 publications

References 43 publications

Topical cyclosporine to control ocular surface disease in patients with chronic glaucoma after long-term usage of topical ocular hypotensive medications

Topical cyclosporine to control ocular surface disease in patients with chronic glaucoma after long-term usage of topical ocular hypotensive medications

Corneal epithelial cells function as surrogate Schwann cells for their sensory nerves

Evaluation of corneal epithelial thickness in glaucomatous patients using anterior‐segment optical coherence tomography

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