Influence of BAK-Preserved Prostaglandin Analog Treatment on the Ocular Surface Health in Patients with Newly Diagnosed Primary Open-Angle Glaucoma

Abstract

Purpose. Primary open-angle glaucoma (POAG), a chronic, degenerative optic neuropathy, requires persistent decrease of intraocular pressure so as to prevent visual impairment and blindness. However, long-term use of topical ocular medications may affect ocular surface health. Purpose of this study was to evaluate the influence of BAK-preserved prostaglandin analog treatment on the ocular surface health in patients with newly diagnosed POAG. Methods. 40 newly diagnosed POAG patients were included in this prospective study. Intraocular pressure (IOP), tear break-up time (TBUT), and ocular surface disease index (OSDI) were assessed at baseline and 3-month after starting treatment with BAK-preserved travoprost 0.004%. Results. IOP decreased in all patients from baseline to 3-month final visit (23.80 ± 1.73 mmHg versus 16.78 ± 1.27 mmHg; P < 0.001). Mean TBUT decreased from 11.70 ± 1.86 seconds at baseline to 8.30 ± 1.29 seconds at 3-month final visit (<0.001). Mean OSDI score increased from 31.63 ± 18.48 to 44.41 ± 16.48 (P < 0.001). Conclusions. This study showed that BAK-preserved travoprost 0.004% is an effective medication in newly diagnosed POAG patients, but its long-term use may negatively influence ocular surface health by disrupting the tear film stability. Further studies are needed to better understand the clinical effects of different preservative types and concentrations on the ocular surface.

Restoring Conjunctival Tolerance by Topical Nuclear Factor–κB Inhibitors Reduces Preservative-Facilitated Allergic Conjunctivitis in Mice

“…To the best of our knowledge, there are no reports on the possible role of conjunctival tolerance in immune exacerbations of ocular surface disease that frequently affect medically treated glaucoma patients. [2][3][4] In this work, we show that prior ocular exposure to an antigen markedly hampers allergic conjunctivitis in systemically immunized mice. It is noteworthy that ocular challenge was performed with an antigen dose 125-fold higher than that used for tolerization, highlighting the powerful protection afforded by conjunctival tolerance.…”

“…L ocal side effects of medical glaucoma treatment represent a significant challenge in clinical practice because of their negative impact on patients' quality of life and compliance. 1 Allergic conjunctivitis and dry eye can arise or worsen after initiating topical treatment with hypotensive eye drops, [2][3][4] and a significant body of evidence suggests that the microbicidal agents in glaucoma formulations are responsible for this phenomenon. 1 The most common among the preservatives approved for human use, benzalkonium chloride (BAK), is found at concentrations ranging from 0.004% (4 3 10 À3 %) to 0.025% (2.5 3 10 À2 %).…”

Ocular Surface Disease in Patients under Topical Treatment for Glaucoma

“…However, others have detected no effects on F-TBUT attributed to the use of eyedrops with preservatives in glaucoma patients (19,43,44). In contrast, a higher burden of BAK-containing IOP-lowering drugs has been associated by some with a shorter TBUT (25,45). Tear film breakup time is measured after instilling preserved saline containing 2% fluorescein from the last blink to the first appearance of a growing dry spot.…”

Fixed-combination intraocular pressure-lowering therapy for glaucoma and ocular hypertension: advantages in clinical practice

“…This finding supports the concern that the increased preservative burden of multiple individual medications should be avoided or minimized when possible. In clinical practice, chronic exposure to preservatives applied in eye drops, particularly BAK, is associated not only with worse OSDI scores but also with increased prevalence of toxic ocular side effects, including decreased tear film stability and tear film breakup time, increased corneal and conjunctival staining and increased tear film osmolarity [70,[72][73][74][75].…”