How Ocular Surface Disease Impacts the Glaucoma Treatment Outcome

Kaštelan, Snježana; Tomić, Martina; Soldo, Kata Metež; Salopek-Rabatić, Jasminka

doi:10.1155/2013/696328

Cited by 65 publications

(67 citation statements)

References 40 publications

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“…17,21,22 Glaucoma patients show a prevalence of OSD in 59% of those using more benzalkonium preservative-containing eye drops, 21 and 47.6% of open angle glaucoma patients have been found to have OSD with a significant impact on visual function and quality of life. 17 The prevalence of OSD in glaucoma patients increases with age 23 and can be compounded with the concurrent use of topical multidose hypotensive therapy containing preservatives. This toxicity has been associated with BAK, which is the most commonly used preservative and causes damage of the conjunctival and corneal epithelial cells and enhances the morbidity of the OSD.…”

Section: Discussionmentioning

confidence: 99%

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%

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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“…It offers the advantage of once-daily dosing as a fixed-dose combination, but contains benzalkonium chloride (BAK) 0.02% w/v, a quaternary ammonium compound that acts as a preservative and solubilizer to dissolve latanoprost. BAK is an antimicrobial preservative commonly used in topical ophthalmic preparations that acts by disrupting microbial cell membranes and promoting cell death 2,25. The use of BAK in ophthalmic solutions, however, has demonstrated a number of disadvantages in both in vitro and in vivo models, including dose-dependent and time-dependent toxicity to the corneal epithelium, the conjunctival epithelium, the stroma, and tear film constituents 25–41.…”

Section: Introductionmentioning

confidence: 99%

“…This new formulation contains the preservatives zinc chloride, boric acid, and tromethamine, and has the potential to avoid the possible disadvantages associated with BAK. Reducing ocular irritation is essential in patients receiving long-term therapy for effective lowering of IOP 2,19,20. In addition, cold-chain storage is not required with this formulation, and its gel-free reservoir technology allows once-daily use, which may further improve treatment adherence 36…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of benzalkonium chloride-free fixed-dose combination of latanoprost and timolol in patients with open-angle glaucoma or ocular hypertension

Bhagat

Sodimalla

Paul³

et al. 2014

OPTH

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BackgroundBenzalkonium chloride (BAK) is a common preservative in topical ocular preparations; however, prolonged use may lead to deleterious effects on the ocular surface, affecting quality of life and reducing adherence to treatment and overall outcomes. This study compared the intraocular pressure (IOP)-lowering efficacy and safety of a novel once-daily, BAK-free, fixed-dose combination of latanoprost plus timolol with latanoprost or timolol administered as monotherapy or concomitantly.MethodsThis was a 6-week, randomized, open-label, parallel-group, active-controlled study in patients aged ≥18 years with open-angle glaucoma or ocular hypertension. A total of 227 patients were randomized to either a once-daily, BAK-free, fixed-dose combination of latanoprost 0.005%/timolol 0.5% ophthalmic solution or concomitant administration of once-daily latanoprost 0.005% plus twice-daily timolol 0.5% or once-daily latanoprost 0.005% monotherapy, or twice-daily timolol 0.5% monotherapy. Efficacy end points were assessed at three time points on visits at weeks 1, 2, 4, and 6 versus baseline.ResultsThe IOP-lowering efficacy of the fixed-dose combination of latanoprost/timolol was similar to that of latanoprost plus timolol administered concomitantly at all time points (mean IOP difference and 95% confidence interval within ±1.5 mmHg; P=0.4223 to P=0.9981). The fixed-dose combination of latanoprost/timolol demonstrated significantly better IOP-lowering efficacy than timolol monotherapy at all time points (P=0.001 to P<0.0001) and significantly better IOP-lowering efficacy than latanoprost monotherapy at all time points. Responder rates on at least one time point and on at least two time points with fixed-dose combination latanoprost/timolol were similar to those with concomitant latanoprost plus timolol (85.5% versus 82.1%, P=0.6360; 78.2% versus 75%, P=0.6923), but significantly better than either latanoprost or timolol monotherapy (68.5%, P=0.0355; 55.4%, P=0.0005; 57.4%, P=0.0202; and 46.4%, P=0.0006, respectively). No significant differences in ocular and nonocular treatment-emergent adverse events were found between the treatment groups.ConclusionA BAK-free, fixed-dose combination of latanoprost 0.005%/timolol 0.5% was as effective and well tolerated as concomitant latanoprost and timolol for treatment of elevated IOP in patients with open-angle glaucoma or ocular hypertension.

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“…Much of this inflammation can be attributed to the preservative, BAK. [5][6][7] BAK is the most commonly used preservative in ophthalmic preparations with a high affinity for membrane proteins and may accumulate in ocular tissues, inducing cell toxicity and/or cell death in a dose-dependent manner. It has also been shown to damage ocular tissue by inducing apoptosis and increasing the concentrations of inflammatory markers.…”

mentioning

confidence: 99%

“…It has also been shown to damage ocular tissue by inducing apoptosis and increasing the concentrations of inflammatory markers. [5][6][7] Travoprost BAK-free ophthalmic solution is the first commercially available preparation of a prostaglandin analogue preserved without BAK. 8 It contains an ionic buffered preservative system, sofZia™ which is an ionic, buffered formula composed of zinc, borate, propylene glycol, and sorbitol.…”

mentioning

confidence: 99%

Efficacy and safety of topical BAK-free travoprost 0.004% versus BAK-preserved travoprost 0.004% in the treatment of primary open angle glaucoma: a comparative study at a tertiary care hospital

Jayanthi

Divyashree

Sujatha

2017

Int J Basic Clin Pharmacol

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Background: Prostaglandin analogues (PGAs) reduce intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG); however, these medications may affect the ocular surface and elicit ocular discomfort when preserved with benzalkonium chloride (BAK). Hence the above study was taken to evaluate the benefit of BAK-free formulations of travoprost. The objectives of the study were to compare the efficacy, safety of topical BAK-free travoprost 0.004% versus BAK-preserved travoprost 0.004% in patients with primary open angle glaucoma.Methods: 40 patients with POAG who fulfilled the inclusion /exclusion criteria were randomised into two groups of 20 each to receive BAK-free travoprost 0.004% or BAK-preserved travoprost once daily in the evening. Efficacy was measured in terms of reduction in IOP monitored at 4, 8 and 12 weeks from baseline. Ocular surface disease index (OSDI) questionnaire was used to assess the ocular surface symptoms. Safety was assessed by monitoring treatment emergent adverse drug reactions (ADRs).Results: Both the study medications were effective in reducing IOP when compared to baseline. Mean IOP reduction from baseline to week 12 was 11±3mmHg (p <0.001), 10.78±3.01mmHg, (p<0.001) in BAK-free travoprost and BAK-preserved travoprost groups respectively. Both produced equivalent reductions in IOP at the end of 4 (7.89±1.82 vs 7.63±2.83, p=0.72), 8 (9.94±2.75 vs10.05±2.75, p=0.90), and 12 weeks (11±3 vs10.78±3.01, p=0.82). BAK-free travoprost demonstrated significantly lower OSDI scores (15.10±3.60) compared to BAK- preserved travoprost (23.47±7.10) at 12 weeks (p <0.0001). There was no significant difference in occurrence of conjunctival hyperaemia between the study drugs (c2 = 0, df = 1, p = 1) and BAK-free travoprost was well tolerated.Conclusions: BAK-free and BAK-preserved travoprost significantly reduced IOP at 12 weeks. But, BAK- free travoprost produced significantly less ocular surface symptoms as compared to BAK- preserved travoprost. Hence it could be a favourable option in POAG patients with ocular surface disease symptoms.

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How Ocular Surface Disease Impacts the Glaucoma Treatment Outcome

Cited by 65 publications

References 40 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

Efficacy and safety of benzalkonium chloride-free fixed-dose combination of latanoprost and timolol in patients with open-angle glaucoma or ocular hypertension

Efficacy and safety of topical BAK-free travoprost 0.004% versus BAK-preserved travoprost 0.004% in the treatment of primary open angle glaucoma: a comparative study at a tertiary care hospital

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