Effects of antiglaucoma drugs on ocular surface

Yalvaç, Ilgaz Saĝdiç; Gedikoğlu, Gökhan; Karagöz, Yasemin; Akgün, Ümit; Nurözler, Ayşe Burcu; Koç, Feray; Kasim, Remzi; Duman, Sunay

doi:10.1111/j.1600-0420.1995.tb00277.x

Cited by 90 publications

(42 citation statements)

References 14 publications

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“…Multiple studies have delineated the deleterious effects of BAK on conjunctival epithelium, corneal epithelium and corneal stroma. 4,[9][10][11][12][13][14][15][16][17][18][19][20] The microscopic changes seen in patients taking BAK include an increase of pro-infl ammatory cytokines, lymphocyte infi ltration, fi broblast proliferation, corneal microvilli loss and goblet cell loss in the conjunctival epithelium. In addition, these ocular surface changes may decrease the success rate of glaucoma surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Along with its antimicrobial activity, BAK is toxic to the corneal epithelium as well as conjunctival epithelium and stroma. 4,[9][10][11][12][13][14][15][16] These changes appear to be both dose-and time-dependent. These toxic side effects come to the forefront in the care of glaucoma patients due to the cumulative amount of BAK that can be introduced through a multiple drop regimen lasting decades.…”

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confidence: 99%

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Effects of prostaglandin analog therapy on the ocular surface of glaucoma patients

Horsley

Kahook²

2009

OPTH

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Purpose: To quantify changes in tear break-up time (TBUT), corneal staining and ocular surface disease index (OSDI) in glaucoma patients after switching therapy from latanoprost with 0.02% benzalkonium chloride (BAK) to travoprost with sofZia ™ . Methods: Prospective consecutive case series evaluating patients before and 8 weeks after switching from latanoprost with BAK to travoprost with sofZia ™ in patients with baseline TBUT less than 6 seconds.Results: Forty eyes of 20 consecutive patients using latanoprost with BAK were switched to travoprost with sofZia ™ . Mean TBUT prior to starting travoprost was 2.02 ± 0.71 seconds and increased to 6.34 ± 1.31 seconds 8 weeks after the switch (p Ͻ 0.001). Mean inferior corneal staining scores decreased from 2.40 ± 0.87 to 1.38 ± 0.59 (p Ͻ 0.001). Mean OSDI scores decreased from 26.31 ± 8.25 to 16.56 ± 6.19 (p Ͻ 0.001). Discussion: This report focuses on the status of the ocular surface, as documented by TBUT, corneal staining and OSDI, in patients switched from latanoprost with BAK to travoprost without BAK. The switch resulted in a statistically signifi cant increase in TBUT and decreases in corneal staining and OSDI in patients with low baseline TBUT values. Conclusion: BAK, a common preservative for glaucoma drops, may increase OSD by disrupting the tear fi lm and increasing conjunctival infl ammation. In this study, a change from a BAK-preserved prostaglandin analog (PGA) to a non-BAK-preserved PGA resulted in a measurable improvement of TBUT, corneal staining and OSDI. Further studies are needed to better understand the impact of BAK-preserved medications on the ocular surface.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Effects of prostaglandin analog therapy on the ocular surface of glaucoma patients

Horsley

Kahook²

2009

OPTH

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“…Antiglaucoma eye drops and benzalkonium chloride have been reported to have deleterious effects on the ocular surface [22,23]. These agents have a detergent effect on the tear film, decreasing goblet cell density [24]. This results in reduced stability of the tear film, which causes superficial punctuate keratopathy.…”

Section: Discussionmentioning

confidence: 99%

Ocular Surface Complications after Trabeculectomy: Incidence, Risk Factors, Time Course and Prognosis

et al. 2013

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Purpose: To investigate the incidence, risk factors, time course and prognosis of ocular surface complications after trabeculectomy. Procedures: This is a retrospective, case-control study. Data on 399 consecutive patients who underwent trabeculectomy between 1999 and 2009 were evaluated. Cases of postoperative corneal epithelial defects, filamentary keratitis and dellen were evaluated. The risk factors for these ocular surface complications were analyzed with a logistic regression model. Results: Corneal epithelial defects were found in 44 of the 399 patients (11%), filamentary keratitis in 12 patients (3%) and dellen in 7 patients (2%). Dellen required surgical intervention at a statistically significantly higher rate than corneal epithelial defects or filamentary keratitis (p = 0.0001, Fisher's exact test). The significant risk factors for these ocular surface complications were found to be a history of preoperative superficial punctate keratopathy (odds ratio, OR: 2.10, 95% confidence interval, CI: 1.25-3.51, p = 0.005) and a history of diabetes mellitus (OR: 1.69, 95% CI: 1.02-2.81, p = 0.04). Conclusions: Ocular surface complications following trabeculectomy are not rare. The biggest risk factors for these complications were found to be a history of preoperative superficial punctate keratopathy and a history of diabetes mellitus. Surgery is likely to be required for the treatment of dellen.

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“…First, corneal and conjunctival fluorescein staining was not evaluated, although this has been extensively studied in the past. 25,35,39,[46][47][48] Second, our study did not consider the possibility that glaucoma patients' (in the medicated and posttrabeculectomy groups) tear function may be due to dry eye that was independent of their glaucoma treatment. Glaucoma patients on concomitant systemic (eg, hormonal pills) 49 or ocular medications (eg, artificial tear lubricants), 50 which can affect dry eye test parameters, were also not considered.…”

Section: Discussionmentioning

confidence: 99%

Effect of chronic anti-glaucoma medications and trabeculectomy on tear osmolarity

Lee

Wong

Chua

et al. 2013

Eye

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Purpose To evaluate the tear film osmolarity (TFO) and ocular surface clinical signs and symptoms in chronically medicated glaucoma patients and post-trabeculectomy patients. Methods This is a single-center, prospective case-controlled study. One-hundred and thirty eyes of 130 participants aged Z45 years were included (49 normal controls, 50 glaucoma patients on chronic preserved antiglaucoma medication Z6 months, and 31 post-trabeculectomy patients not on medication Z6 months). TFO, tear break-up time (TBUT), Schirmer's test I and dry eye symptoms were evaluated. Data from both groups of glaucoma patients were compared with age and sex-matched controls. Logistic regression was performed to calculate the odds ratios. Results Mean TFO in the three groups were 301.4 ± 7.7, 307.0 ± 9.3, and 307.4 ± 11.6 mOsm/l, respectively. Compared with normal controls, chronically medicated glaucoma patients and post-trabeculectomy patients were more likely to have a raised TFO, with odds ratios (95% CI) of 4.43 (1.74-11.32) and 2.76 (1.02-7.94), respectively. Both groups of glaucoma patients were also more likely to experience dry eye symptoms, with ORs of 4.72 (1.92-11.59) and 4.24 (1.54-11.72). There was no significant difference in TFO and symptoms between both groups of glaucoma patients, and in TBUT and Schirmer's test across all three groups. Conclusions Patients on chronic topical antiglaucoma medication and posttrabeculectomy patients were more likely to have raised TFO and dry eye symptoms, suggesting significant ocular surface disease. Glaucoma practitioners should be aware that dry eye symptoms and raised TFO may occur in the absence of TBUT and Schirmer's test abnormality.

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Effects of antiglaucoma drugs on ocular surface

Cited by 90 publications

References 14 publications

Effects of prostaglandin analog therapy on the ocular surface of glaucoma patients

Effects of prostaglandin analog therapy on the ocular surface of glaucoma patients

Ocular Surface Complications after Trabeculectomy: Incidence, Risk Factors, Time Course and Prognosis

Effect of chronic anti-glaucoma medications and trabeculectomy on tear osmolarity

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