Conjunctiva and subconjunctival tissue in primary open-angle glaucoma after long-term topical treatment: an immunohistochemical and ultrastructural study

Nuzzi, Raffaele; Vercelli, Alessandro; Finazzo, C.; Cracco, Cecilia Maria

doi:10.1007/bf00166608

Cited by 78 publications

(57 citation statements)

References 20 publications

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“…Long-time usage of antiglaucomatous agents was shown to cause irreversible chronic conjunctival inflammation and fibrosis which yields a low success rate in filtration surgery [4,5,6,7,11,12,13,14,38,39,40]. It was shown that the changes were more prominent in patients treated with more than one drug and with increased duration of time [7, 11].…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Ocular Surface Side Effects of Topical Travoprost and Bimatoprost

Alagöz

Bayer²,

Boran³

et al. 2008

Ophthalmologica

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Purpose: To compare the subjective symptoms, conjunctival hyperemia, tearing response and conjunctival cytological changes secondary to topical administration of bimatoprost and travoprost for 6 months. Methods: Newly diagnosed primary open-angle glaucoma patients were randomly prescribed bimatoprost (35 cases) or travoprost (42 cases). Two patients in each group were excluded because they did not appear at their appointments regularly. Thus, 33 and 40 patients completed the study in the bimatoprost and travoprost groups, respectively. Redness, itching, foreign-body sensation, pain and discomfort were assessed by a questionnaire, and patients were examined for conjunctival hyperemia. Schirmer’s I and break-up time tests were performed, and impression cytology of conjunctiva was evaluated. Results: Subjective symptoms were similar in both groups. The only subjective symptom that changed significantly was redness. The change in conjunctival hyperemia along the study period correlated with the patient-reported redness in both groups, being highest on day 30. Schirmer’s test I and break-up time did not change with time and were similar in both groups. The impression cytology grade increased with time in both groups with the only significant difference between groups on day 90 (higher in the bimatoprost group). Conclusion: We observed conjunctival hyperemia as the most common side effect of bimatoprost and travoprost. Tear film functions were not affected by these drugs while cytological alterations were.

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Section: Discussionmentioning

confidence: 99%

“…The conjunctiva is a living tissue and can respond to topical medication with inflammation, scarring, keratinization and neovascularization [2,3,4,5,6,7]. Topical medications may also have an adverse effect on the tear film and on mucus production [3, 8].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Ocular Surface Side Effects of Topical Travoprost and Bimatoprost

Alagöz

Bayer²,

Boran³

et al. 2008

Ophthalmologica

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“…Ис-пользование даже одного вида капель в течение трёх лет и более также ассоциировано с разви-тием воспаления и инфильтрацией фибробласта- ми, что напрямую коррелирует с повышенным риском неэффективности хирургического вмеша-тельства [22]. Обследуя пациентов, находящихся на длительной местной терапии, R. Nuzzi (1995) подтвердил факт существенного утолщения слоёв эпителиальных клеток, увеличения численности фибробластов в субэпителиальном и глубоком со-единительнотканном слое и уплотнение соедини-тельной ткани, в которой возрастает содержание коллагеновых волокон, упорядоченных в виде за-витков, и усиливается экспрессия маркеров вос-паления [33]. По данным C. Baudouin (1999), ре-зультаты иммуногистологических исследований образцов конъюнктивы и трабекулы пациентов, готовящихся к антиглаукомной операции, свиде-тельствуют о том, что на фоне медикаментозной терапии имеет место более выраженная экспрес-сия маркеров активации фибробластов и мар-керов воспаления, чем в его отсутствие.…”

Section: The Influence Of Local Iop-lowering Therapy On the Anterior unclassified

“…Результаты других исследований позволяют выдвинуть гипотезу о том, что местная терапия, возможно, по причине содержания консервантов может играть определённую роль в созревании катаракты [33], а также в увеличении частоты встречаемости кистозного макулярного отёка, диагностируемого по результатам ангиографии, после оперативного вмешательства по поводу ка-таракты [17]. Гибель клеток и выработка сигналов каскада воспаления, имеющие место в подлежа-щих структурах (тенонова капсула, субконъюн-ктивальное пространство и даже трабекулярная сеть), могут принимать непосредственное уча-стие в индукции послеоперационного воспаления и фиброза и обусловливать последующее повы-шение внутриглазного давления.…”

Section: The Influence Of Local Iop-lowering Therapy On the Anterior unclassified

The influence of local IOP-lowering therapy on the anterior segment tissues and outcome of glaucoma filtering surgery

Petrov

Юрьевич²,

Lovpache

et al. 2017

Ophthalmology Reports

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Nowadays, a wide choice of local IOP-lowering medications allows ensuring a successful intraocular pressure compensation and primary open angle glaucoma stabilization. However, taking into consideration a long term action of drugs on the ocular surface, even without clinical manifestations there is a direct inflammatory cells’ activation with mixed toxic and allergic changes, which is confirmed by histology, immune-histology, and impression cytology methods. Such chronic sub-clinical inflammation represent a potential risk of excessive fibroblast proliferation with subsequent rapid postoperative scarring of new outflow pathways and atypical filtration bleb formation. It is shown that there is a clear relationship between number of glaucoma drugs used, treatment duration, intensity of conjunctival infiltration with inflammatory cells and fibroblasts, and risk of episcleral fibrosis and subconjunctival scarring during post-op period. (For citation: Petrov SYu, Lovpache DzhN, Loskutov IA, Safronova DM. The influence of local IOP-lowering therapy on the anterior segment tissues and outcome of glaucoma filtering surgery. Ophthalmology Journal. 2017;10(4):41-47. doi: 10.17816/OV10441-47).

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“…But although most of the studies report conjunctival inflammation in prostaglandin analogues users 7,8,10,12 , this feature may also be present in patients under the use of other antiglaucomatous drugs 9,10,[13][14][15] .…”

Section: Introductionmentioning

confidence: 99%

Conjunctival inflammation in patients under topical glaucoma treatment with indication to surgery

Furtado¹,

Paula²,

Soares³

et al. 2012

Acta Cir. Bras.

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PURPOSE:To compare the frequency of conjunctival HLA-DR expression (a surrogate marker for inflammation) in eyes treated with topical prostaglandin analogues versus eyes treated with other topical antiglaucomatous drugs. METHODS: Patients diagnosed with primary open-angle glaucoma presenting indication for trabeculectomy were divided in groups according to the use or not of prostaglandin analogues. All subjects were treated with the maximum tolerated dose of antiglaucomatous drugs until the date of the surgery. At the beginning of the surgical procedure, a 5 x 5 mm biopsy of the bulbar conjunctiva was collected, incubated with monoclonal anti-HLA-DR antibody and processed for histological analysis. RESULTS: Of the 31 eyes included (31 patients), 25 were under topical prostaglandin analogues (Group 1) and six under other topical pharmacological agents (Group 2). Fourteen eyes of Group 1 (56%) and three of Group 2 (50 %) were positive for the inflammatory marker HLA-DR (P=1.0). The percentage of stained cells ranged from 15.49 to 48.09% (median: 27.61) in Group 1, and from 18.35 to 28 (median: 20.71) in Group 2, with no differences statistically significant (p=0.33). CONCLUSION: The use of prostaglandin analogues did not increase conjunctival expression of HLA-DR compared to other topical antiglaucomatous agents.

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Conjunctiva and subconjunctival tissue in primary open-angle glaucoma after long-term topical treatment: an immunohistochemical and ultrastructural study

Abstract: According to these results, antiglaucomatous surgery should be rehabilitated and considered as an alternative to long-term medical therapy in the first-instance treatment of primary open-angle glaucoma.

Cited by 78 publications

References 20 publications

Comparison of Ocular Surface Side Effects of Topical Travoprost and Bimatoprost

Comparison of Ocular Surface Side Effects of Topical Travoprost and Bimatoprost

The influence of local IOP-lowering therapy on the anterior segment tissues and outcome of glaucoma filtering surgery

Conjunctival inflammation in patients under topical glaucoma treatment with indication to surgery

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