Influence of Treating Ocular Surface Disease on Intraocular Pressure in Glaucoma Patients Intolerant to Their Topical Treatments: A Report of 10 Cases

Abstract

Purpose: The purpose of this study was to evaluate the effect of treating ocular surface disease (OSD) in patients with medically uncontrolled primary open-angle glaucoma (POAG) associated with OSD. Methods: We compiled a retrospective observational case series of 10 patients with POAG that remained uncontrolled with topical treatments and who were referred for filtering glaucoma surgery. All patients underwent a complete assessment of their glaucoma and ocular surface for both eyes. The main treatments were change of topical antiglaucoma medications to preservative-free equivalents, removal of allergenic treatments or those identified as causing side effects, switch to another therapeutic class with the same efficacy but with a better safety profile and treatment of OSD. Results: After a minimum follow-up of 6 months, we observed improved ocular surface in all patients, associated with an intraocular pressure (IOP) decrease or stabilization even if some antiglaucoma medications were removed. The mean IOP significantly decreased from 23.75±9.98 mm Hg to 15.15±4.75 mm Hg (−36.2%; P=0.0001). The mean number of IOP-lowering medications was 3.7±1.06 at presentation and 2.8±0.63 after treatment (P=0.01). The Oxford score also decreased from a mean 1.7±0.67 to 0.4±0.51 (−76.5%; P<0.001). For 2 patients, IOP was not sufficiently reduced after treatment and they finally underwent filtering surgery. Conclusions: The prevalence of OSD in POAG patients is very high, particularly in patients with uncontrolled glaucoma with multiple topical medications. Careful management of the ocular surface associated with a reduction of the toxicity of eyedrops may result in improvement of ocular surface health and better IOP control.

Preservative‐free versus preserved glaucoma eye drops and occurrence of glaucoma surgery. A retrospective study based on the French national health insurance information system, 2008‐2016

“…More recent studies found preserved medication trigger inflammatory effects and enhanced trabecular degeneration (Baudouin et al 1999; Baudouin et al, 2012a,2012b; Batra, Tailor & Mohamed 2014; Dubrulle et al 2018). The use of PF eye drops could therefore lead to a decreased risk of surgery by preserving the ocular surface and the trabecular meshwork, but also by improving compliance.…”

“…Even though the aim of the present study was not to assess the mechanisms of the influence of preservatives on the occurrence of further glaucoma surgery, there is a body of evidence in the literature which may be used for a fair and documented hypothesis. The switch from preserved to preservative‐free eye drops resulted in an improvement of the Ocular Surface Disease Index (OSDI) (Henry et al 2008), a decrease in conjunctival hyperaemia (Januleviciene et al 2012; Denis 2016) and subjective complaints (Hommer et al 2018), and an increase in tear film thickness and breakup time (Dubrulle et al 2018). Dubrulle et al (2018) also suggested that treating ocular surface disease improved intraocular pressure (the mean IOP significantly decreased by 36.2% with a mean number of IOP‐lowering medications decreasing from 3.7 at baseline to 2.8; the Oxford score also decreased significantly by 76.5%) by stopping local inflammation.…”

“…The switch from preserved to preservative‐free eye drops resulted in an improvement of the Ocular Surface Disease Index (OSDI) (Henry et al 2008), a decrease in conjunctival hyperaemia (Januleviciene et al 2012; Denis 2016) and subjective complaints (Hommer et al 2018), and an increase in tear film thickness and breakup time (Dubrulle et al 2018). Dubrulle et al (2018) also suggested that treating ocular surface disease improved intraocular pressure (the mean IOP significantly decreased by 36.2% with a mean number of IOP‐lowering medications decreasing from 3.7 at baseline to 2.8; the Oxford score also decreased significantly by 76.5%) by stopping local inflammation. Mutual relationships between ocular surface and external filtration surgery were widely proven in vitro and in vivo (Baudouin 2017).…”

“…The switch from preserved to preservativefree eye drops resulted in an improvement of the Ocular Surface Disease Index (OSDI) (Henry et al 2008), a decrease in conjunctival hyperaemia (Januleviciene et al 2012;Denis 2016) and subjective complaints (Hommer et al 2018), and an increase in tear film thickness and breakup time (Dubrulle et al 2018). Dubrulle et al (2018) also suggested that treating ocular surface disease improved (Baudouin 2017). Furthermore, preservative effects might not be restricted to the ocular surface and recent studies suggested that BAK could accumulate in the anterior chamber where it may also exert toxicity by producing inflammation (Stevens et al 2012) and decrease trabecular meshwork (TM) cell viability via induction of apoptosis (Ammar & Kahook 2011a,2011b.…”

“…More recent studies found preserved medication trigger inflammatory effects and enhanced trabecular degeneration (Baudouin et al 1999;Baudouin et al, 2012aBaudouin et al, ,2012bBatra, Tailor & Mohamed 2014;Dubrulle et al 2018).…”