The effect of successful trabeculectomy on the ocular surface and tear proteomics—a prospective cohort study with 1‐year follow‐up

Abstract

Purpose To report changes in the ocular surface and tear proteomics after discontinuation of chronic glaucoma medication. Methods Patients requiring trabeculectomy were recruited from the glaucoma clinic of Tampere University Hospital, Finland. Fifty‐seven patients with previous history of anti‐glaucomatous eye drops (8.1 ± 6.8 years) and having undergone a successful trabeculectomy were included in this report. Outcomes of interest were conjunctival redness grading, tear secretion (Schirmer I) and tear film proteomics (SWATH‐MS) in addition to thorough clinical examination. The protocol included five time points: preoperative visit and postoperative visits at month 1, 3, 6 and 12. All parameters measured were compared to the corresponding preoperative levels of each individual eye. Results Conjunctival redness and irritation were significantly reduced during follow‐up, while tear production remained unchanged. Protein profiles of the tear film indicated significant changes in the ocular surface. Lipid transport was increased while several pro‐inflammatory proteins were consistently decreased after the surgery. Conclusion Clinical signs as well as the proteomics results indicated that the trabeculectomy and resulting cessation of topical glaucoma medication were very beneficial to the ocular surface. The state of the conjunctiva improved throughout the 1‐year follow‐up while the levels of pro‐inflammatory proteins decreased and lipid transport‐associated functions were increased.

Inter-Eye Comparison of the Ocular Surface of Glaucoma Patients Receiving Surgical and Medical Treatments

“…We assumed conjunctival hyperemia as a primary outcome. Hyperemia is present in nearly all medically treated eyes ( p 1 = 0.95), and surgery is frequently associated with hyperemia reduction; we assumed a 40% reduction of hyperemia as clinically relevant ( p 2 = 0.55) [ 27 , 28 , 29 ]. With α/2 = 0.05 and β = 0.8, Δ = 0.40, 25 patients were necessary in this study.…”

Clinical Tear Fluid Proteomics—A Novel Tool in Glaucoma Research

“…Burgos-Blasco et al [ 105 ] identified that high levels of IL8 in tears could predict lower IOP reduction. A study by Vaajanen et al [ 106 ], on the other hand, examined how the tear protein levels change after trabeculectomy. In this study, trabeculectomy patients were followed for 1 year after surgery and the results indicated an improvement in the ocular surface state both clinically and at the protein level.…”

A Narrative Review of Ocular Surface Disease Related to Anti-Glaucomatous Medications

“…Although OSD caused by glaucoma filtration surgery is common, given that the long-term use of anti-glaucomatous medications and topical steroid infusion after surgery may have a positive impact on the ocular surface status, surgical treatment is still beneficial to reduce OSD [159,160]. A 1-year follow-up study showed the improved conjunctival state, the decreased level of pro-inflammatory protein, and the enhanced function related to lipid transport in patients after trabeculectomy [161]. In addition, selective laser trabeculoplasty or minimally invasive glaucoma surgery may be a more appropriate choice for patients with glaucoma and OSD.…”