Objective ocular surface tolerance in patients with glaucoma treated with topical preserved or unpreserved prostaglandin analogues

2018 ◽  
Vol 29 (6) ◽  
pp. 645-653 ◽  
Author(s):  
Ammar El Ameen ◽  
Guillaume Vandermeer ◽  
Raoul K Khanna ◽  
Pierre-Jean Pisella
Keyword(s):  
Intraocular Pressure ◽  
Prostaglandin Analogue ◽  
Ocular Toxicity ◽  
Prostaglandin Analogues ◽  
Conjunctival Hyperaemia ◽  
Ocular Symptoms ◽  
Tear Meniscus ◽  
Tear Meniscus Height ◽  
Preservative Free ◽  
Ocular Signs

Purpose: Preservatives in glaucoma medications have been associated with ocular toxicity. We compared ocular signs and symptoms in patients with open-angle glaucoma or ocular hypertension treated in monotherapy with preserved or preservative-free prostaglandin analogues. Methods: Observational cross-sectional clinical study in real life. 82 patients treated for at least 6 months with prostaglandin analogue were assessed for intraocular pressure, ocular symptoms and ocular signs including conjunctival hyperaemia, tear break-up time and tear meniscus height measured using objective and non-invasive methods (OCULUS Keratograph 5M). Patients presenting with symptoms of ocular toxicity with preserved prostaglandin analogues were switched to preservative-free latanoprost, and a second assessment was processed 6 months after. Results: At inclusion, 30 (36.6%) patients were treated with preservative-free latanoprost, 25 (30.5%) with preserved latanoprost, 16 (19.5%) with preserved travoprost and 11 (13.4%) with preserved bimatoprost. Patients treated with preservative-free latanoprost reported significantly less ocular symptoms upon instillation (mainly burning) and between instillations than patients treated with preserved prostaglandin analogues. The mean conjunctival hyperaemia (limbal + bulbar) was significantly lower with preservative-free latanoprost (2.08 ± 0.55) compared to preserved latanoprost (2.50 ± 0.7, p = 0.0085), preserved travoprost (2.67 ± 0.82, p = 0.0083) and preserved bimatoprost (2.68 ± 0.67, p = 0.0041). There were no relevant between-group differences in mean tear meniscus height and break-up time. Ocular symptoms and conjunctival hyperaemia improved when preserved prostaglandin analogues were switched to preservative-free latanoprost for 6 months while intraocular pressure reduction was maintained. Conclusion: Overall, this study suggests a better subjective and objective ocular tolerance when patients were treated with preservative-free latanoprost than with other preserved prostaglandin analogues monotherapy. Switching to preservative-free latanoprost maintained intraocular pressure at the same level as preservative prostaglandin analogue, but improved ocular surface tolerance.

Prostaglandin analogues: A double-edged sword in orbital glaucoma disease management

2020 ◽  
pp. 112067212090529
Author(s):  
Varajini Joganathan ◽  
Paul S Cannon ◽  
Karl Mercieca
Keyword(s):  
Intraocular Pressure ◽  
Adverse Effects ◽  
Ocular Hypertension ◽  
Pressure Rise ◽  
Eye Drops ◽  
Prostaglandin Analogue ◽  
Prostaglandin Analogues ◽  
Patient Reported ◽  
The Aesthetic ◽  
Orbital Disease

Introduction: The authors describe benefits of the recognised adverse effects of prostaglandin analogues on periocular structures in patients with unilateral proptosis and intraocular pressure rise. This case points to intentional consideration of prostaglandin analogue therapy in this selected cohort of patients with secondary ocular hypertension and proptosis. Case description: A 70-year-old gentleman who presented with a 1-week history of a red and painful right eye associated with tortuous and dilated episcleral blood vessels. Visual acuity was unaffected. A diagnosis of idiopathic orbital inflammatory disease was made by extraocular muscle biopsy. Two weeks later, the patient presented with worsening pain, reduced vision and raised intraocular pressure. The secondary ocular hypertension was successfully treated with topical preserved eye drops, including latanoprost, a prostaglandin analogue. Over 6 months, the patient developed drop intolerance and punctate keratopathy leading to therapy non-adherence. Interestingly, the patient reported improvement in periocular appearance related to prostaglandin-associated periorbitopathy. Ocular surface disease and intraocular pressures were subsequently managed with preservative-free eye drops. Conclusion: Secondary ocular hypertension is not an uncommon consequence of orbital disease. Prostaglandin analogue can act as a double-edged sword in the management of raised intraocular pressure by reducing eye pressure at the cost of developing adverse effects of prostaglandin-associated periorbitopathy. These adverse effects however can be beneficial in the aesthetic rehabilitation of proptosis and associated exposure keratopathy in patients with unilateral orbital disease and probably should be sought as first line treatment in those with proptosis and raised intraocular pressure.

scholarly journals An investigation of the relationship between tear meniscus height and the subjective severity of ocular symptoms in keratoconus

2015 ◽  
Vol 74 (1) ◽  
Author(s):  
Deanne L. Nicholas ◽  
Wayne D.H. Gillan
Keyword(s):  
Dry Eye ◽  
Objective Measures ◽  
Ocular Surface Disease Index ◽  
Ocular Symptoms ◽  
Body Sensation ◽  
Associated Conditions ◽  
Tear Meniscus ◽  
Tear Meniscus Height ◽  
Ocular Comfort ◽  
The Relationship

Keratoconus is a debilitating disease in which the cornea does not develop its characteristic round shape but develops into a conical form affecting both functional vision as well as ocular comfort. Depending on the severity of the keratoconus as well as the presence of any associated conditions, keratoconic individuals may complain of various symptoms that include discomfort, irritation, dryness, reflex tearing and foreign body sensation. There are various subjective and objective measures that can be used to determine the severity of these symptoms. A subjective method that is widely used is the ocular surface disease index (OSDI) which has been shown to be fairly accurate when diagnosing dry eye disease; however, these symptoms do not correlate with objective measures of dry eye. Research has revealed the various structural and biochemical changes that take place within a keratoconic cornea; however, the tear dimensions of keratoconic subjects have not been extensively investigated. It is possible that the symptoms experienced by many keratoconic individuals might be linked to alterations within the quantity of the tears of these patients. The present study compared the symptoms experienced by keratoconic individuals with the symptoms of control patients. The differences in tear meniscus heights between keratoconic individuals and those of control individuals were also compared using the Oculus Keratograph 4 (OK4). The results of the study show the absence of a relationship between the subjective symptoms experienced and the height of the tear meniscus.

scholarly journals Ocular Surface Changes in Prostaglandin Analogue-Treated Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Wencui Shen ◽  
Bingqing Huang ◽  
Jin Yang
Keyword(s):  
Intraocular Pressure ◽  
Ocular Surface ◽  
Prostaglandin Analogue ◽  
First Line ◽  
Prostaglandin Analogues ◽  
First Line Therapy ◽  
Line Therapy ◽  
Ocular Changes ◽  
The Relationship ◽  
Surface Changes

Glaucoma is the second leading cause of blindness globally. Reducing intraocular pressure (IOP) has been acknowledged to be the main therapy for glaucoma. Prostaglandin analogues (PGAs) have become the first-line therapy for patients with glaucoma due to their powerful efficacy for lowering (IOP). However, usage of PGAs can also cause several notable side effects, including the changes in ocular surface. The relationship between PGAs and ocular surface changes is complicated and still remains unclear. In the present review, we summarize the recent studies of the effects of PGAs on ocular changes as well as the possible mechanisms that might provide new considerations during clinical medication.

scholarly journals Ocular surface conditions in Asian glaucoma patients with existing corneal disorders switching from preserved prostaglandin analogue monotherapy to preservative-free tafluprost

2021 ◽  
Vol 3 (3) ◽  
pp. 109-122
Author(s):  
Hsien Han Lim ◽  
Thanendthire Sangapillai
Keyword(s):  
Intraocular Pressure ◽  
Ocular Surface ◽  
Open Angle Glaucoma ◽  
Ocular Surface Disease ◽  
Prostaglandin Analogue ◽  
Ocular Surface Disease Index ◽  
Open Label ◽  
Fluorescein Staining ◽  
Staining Score ◽  
Preservative Free

Introduction: Glaucoma medications are often preserved with agents such as benzalkonium chloride, which commonly lead to ocular surface diseases.Purpose: To investigate the effect of switching to a preservative-free prostaglandin analogue, tafluprost 0.0015% on treatment tolerability and ocular surface diseases.Study design: This was a prospective, open-label, non-randomised, observational study performed in a single hospital.Materials and methods: This study involved patients of Asian descent diagnosed with primary open-angle glaucoma and ocular hypertension (n = 28), who received preserved prostaglandin monotherapy for longer than 3 months and had a National Eye Institute ocular surface staining scale score higher than 1. Patients were switched from preserved prostaglandin monotherapy to preservative-free tafluprost 0.0015%. Patients were analysed at baseline (Visit 0), 1 month (Visit 1), and 3 months (Visit 2). The main parameter measured is the change in the fluorescein staining score at Visit 2.Results: There was a significant improvement in the fluorescein staining score, with a mean reduction score of 1.96 (standard deviation, SD = 1.53; p < 0.0001), and significant reductions in conjunctival hyperaemia (bulbar, p < 0.0001; palpebral, p < 0.05) from baseline to Visit 2. The Ocular Surface Disease Index questionnaire also showed a mean reduction of 4.14 from baseline to visit 2 (SD = 8.20; p < 0.05). The intraocular pressure and tear breakup time were maintained from baseline to Visit 2.Conclusion: Switching patients to preservative-free tafluprost 0.0015% showed significant improvements in ocular surface disease with minimal side effects and similar intraocular pressure reduction rates.

scholarly journals AB0162 OCULAR MANIFESTATIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1108.1-1108
Author(s):  
D. Monova ◽  
S. Monov ◽  
R. Shumnalieva ◽  
D. Dimova ◽  
M. Sotirova
Keyword(s):  
Rheumatoid Arthritis ◽  
Intraocular Pressure ◽  
Disease Duration ◽  
Keratoconjunctivitis Sicca ◽  
Retinal Vasculitis ◽  
Standard Test ◽  
Systemic Autoimmune Disease ◽  
Ophthalmological Examination ◽  
Schirmer’S Test ◽  
Ocular Symptoms

Background:Rheumatoid arthritis (RA) is the most common systemic autoimmune disease and is associated with a number of extra-articular organ manifestations, including ocular complications.Objectives:The aim of this study is to evaluate the frequency and characteristics of ocular manifestation in patients with rheumatoid arthritis (RA).Methods:The study involved 87 patients with RA. All the study subjects underwent complete ophthalmological examination involving visual acuity assessment, examination of anterior and posterior eye segments, Schirmer’s test, diameter and mobility of pupils, as well as eyeball mobility assessment of intraocular pressure. Data regarding age, gender, disease duration, age at diagnosis, systemic corticosteroid use, blood pressure, ocular symptoms and detailed ophthalmic history were recorded. The presence of rheumatoid factor in serum was evaluated by standard test methods based on principle of agglutination. All patients were seropositive.Results:87 patients (26 male, 59 female, mean age 45,6 ± 13,1 years; mean disease duration 7,4 ± 6,2 years) with RA were enrolled in this study. 31 (35,63 %) of them had no ocular symptoms. Among the patients with ocular symptoms, 39 (69,64 %) complained of decreased vision, 33 (58,93 %) - of dry eye, 32 (57,14 %) - of burning, 29 (51,78 %) -photophobia, 28 (50 %) - of gritty sensation, 27 (48,21 %) - of itching, 18 (32,14 %) - of redness, 13 (23,21 %) - of ocular pain, 3 (5,36 %) - of floaters. Ophthalmological examination revealed higher incidence of the following abnormalities in the study group: myopic astigmatism - in 10 (5,74 %) eyes, vascular abnormalities within fundus - in 22 (12,64 %) eyes, increased intraocular pressure (> 21 mm Hg) - in 11 (6,32 %) eyes. Mean IOP values were 17,34 ± 5,12 mm Hg. In 48 eyes Schirmer’s test results were below 10 mm, and in 18 eyes - below 5 mm. Keratoconjunctivitis sicca was present in 31 (35,63 %) of all patients. Episcleritis was diagnosed in 4 patients (4,6 %), scleritis – in 3 (3,45 %). Retinal vasculitis was present in 2 (2,3 %) patients and involves veins and arteries peripheral branches. Lens opacity was found in 13 (14,94 %) patients (21 eyes), mostly in the form of posterior subcapsular cataract (in 16 eyes) and nuclear cataract (in 5 eyes). The mean age of patients with cataracts was 52,3 ± 14,2 years. 13 of the patients with cataracts were either currently taking or had previously taken systemic corticosteroids.Conclusion:In patients with RA numerous abnormalities within the vision of organ may be found. Ocular symptoms are relatively common complications of RA, and may result in irreversible changes in the organ of vision. Regular ophthalmological examinations are essential among the patients with RA.Disclosure of Interests:None declared

Ocular Symptoms and Signs with Preserved and Preservative-Free Glaucoma Medications

2007 ◽  
Vol 17 (3) ◽  
pp. 341-349 ◽  
Author(s):  
N. Jaenen ◽  
C. Baudouin ◽  
P. Pouliquen ◽  
G. Manni ◽  
A. Figueiredo ◽  
...  
Keyword(s):  
Ocular Symptoms ◽  
Symptoms And Signs ◽  
Preservative Free

SCREENING FOR DRY EYE IN TYPE II DIABETIC PATIENTS IN A TERITIARY EYE CARE HOSPITAL

2021 ◽  
pp. 23-25
Author(s):  
Vepa Meenakshi ◽  
Maridi Aparna ◽  
Tammana v
Keyword(s):  
Dry Eye ◽  
Structural Damage ◽  
Screening Tests ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Meniscus Height ◽  
Tear Meniscus ◽  
Break Up ◽  
Tear Meniscus Height

AIM: To screen for dry eye among type 2 diabetic patients ,determine the prevalence and correlate with blood sugar levels. METHODS: 100 patients who were diagnosed cases of type 2 diabetes were included in the study .Detailed history regarding ocular symptoms, diabetes and its duration was taken. A thorough ocular examination using Slit lamp bio microscopy was done and visual acuity tested with Snellen's chart.Tear lm status evaluated by Schirmer's I test, Tear lm break up time(TBUT),Tear meniscus height. Two or all of the above performed tests was positive in a given patient, the patient was deemed to be suffering from dry eye. RESULTS:Out of 100 patients, males were 48 and females were 52. 39 patients were found to show positive screening tests for dry eye.38% (out of 39 patients) had major symptom of foreign body sensation. 23 out of 39 patients were females. 14 out of 39 patients were in age group 51 to 60 years.Most of the diabetics with dry eye had duration of disease 5 to 10 years .39 patients had Tear Break Up time <10 sec, 25 patients had Tear Meniscus Height <0.25mm and 36 patients had Schirmers I test<10mm.Diabetics with dry eyes had average RBS of 179.63+57.28 and PPBS of 247.75+88.39 mg/dl. These values were more when compared to diabetics with no dry eye. CONCLUSION: Early ocular examination in Diabetic patients and good glycemic control should be done considering increased incidence of dry eyes.This should be an integral part of the assessment of diabetic eye disease so as to improve the patient's comfort and to prevent or minimize further structural damage to the ocular surface.

scholarly journals The RELIEF study: Tolerability and efficacy of preservative-free latanoprost in the treatment of glaucoma or ocular hypertension

2018 ◽  
Vol 29 (2) ◽  
pp. 210-215 ◽  
Author(s):  
Marta Misiuk-Hojlo ◽  
Maria Pomorska ◽  
Malgorzata Mulak ◽  
Marek Rekas ◽  
Joanna Wierzbowska ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Standard Deviation ◽  
Ocular Hypertension ◽  
Benzalkonium Chloride ◽  
Tear Film ◽  
Corrected Visual Acuity ◽  
Break Up ◽  
Preservative Free ◽  
Best Corrected Visual Acuity

Purpose: To assess tolerability and efficacy following a switch from benzalkonium chloride–latanoprost to preservative-free latanoprost in patients with glaucoma or ocular hypertension. Methods: A total of 140 patients with glaucoma or ocular hypertension controlled with benzalkonium chloride-latanoprost for at least 3 months were switched to treatment with preservative-free latanoprost. Assessments were made on days 15, 45, and 90 (D15, D45, and D90) and included best-corrected visual acuity, intraocular pressure, slit lamp examination, fluorescein staining, tear film break-up time, patient symptom evaluation, and subjective estimation of tolerability. Results: Mean best-corrected visual acuity remained unchanged during the study. Mean intraocular pressure compared with baseline (D0) remained stable throughout the study (D0, 15.9 mmHg (standard deviation = 2.6); D90, 15.3 mmHg (standard deviation = 2.4); p < 0.006). Tear film break-up time improved or remained unchanged relative to baseline in 92% of patients at D45 and in 93% at D90. Moderate-to-severe conjunctival hyperemia was seen in 56.8% of patients at D0, but this figure decreased to 13.7%, 2.2%, and 1.6% at D15, D45, and D90, respectively. Subjective assessment of tolerability (0–10 scale) indicated improvement with change of therapy (mean score: 5.3 (standard deviation = 2.2) at D0 versus 1.9 (standard deviation = 1.7) at D90; p < 0.0001). Conclusion: Preservative-free latanoprost has at least the same intraocular pressure-lowering efficacy as benzalkonium chloride–latanoprost, with a better tolerability profile. This may translate into greater control of treatment and improved quality of life.

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