A comparative study of benzalkonium chloride-free latanoprost versus benzalkonium chloride-preserved latanoprost on ocular surface health in patients of primary open angle glaucoma

Background: Prolonged use of anti-glaucoma therapy leads to development of ocular surface disease (OSD). The purpose of this study was to compare the effect of Benzalkonium chloride (BKC)-free latanoprost and Benzalkonium chloride (BKC)-preserved latanoprost on ocular surface health in patients of primary open angle glaucoma (POAG).Methods: This was a prospective, open-label, randomized, interventional, switch trial. 30 established cases of POAG who were already on BKC-preserved latanoprost for atleast more than three months were enrolled. Their Schirmer test and Tear film break-up time (TBUT) were recorded at the baseline. They were required to answer an ocular surface disease index (OSDI) questionnaire from which an OSDI score was calculated. They were switched to BKC-free latanoprost for another three months. On their follow-up visit at 6 weeks and 12 weeks, Schirmer test and Tear film break up time were performed again and OSDI score was calculated.Results: Schirmer test increased from 6.73±3.77 mm at baseline to 9.53±3.67 mm at 6 weeks and 11.97±3.53 mm at 12 weeks (p=0.001). Mean TBUT improved significantly from 6.77±3.82 seconds at baseline to 8.63±3.91 seconds at 6 weeks to 10.47±3.76 seconds at 12 weeks (p=0.001). OSDI score decreased from 31.55±23.32 at baseline to 23.42±21.93 at 6 weeks to 15.82±20.10 at 12 weeks (p=0.001).Conclusions: BKC-free latanoprost led to improvement in tear film status or ocular surface health of glaucoma patients as compared to BKC-preserved latanoprost.

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

BioMed Research International ◽

10.1155/2013/603782 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 9

Author(s):

Martina Tomić ◽

Snježana Kaštelan ◽

Kata Metež Soldo ◽

Jasminka Salopek-Rabatić

Keyword(s):

Intraocular Pressure ◽

Ocular Surface ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Final Visit ◽

Open Angle ◽

Newly Diagnosed ◽

Prostaglandin Analog ◽

Ocular Surface Health

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 from11.70±1.86seconds 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.

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The influence of glaucoma medications on ocular surface disease in primary open-angle glaucoma patients with and without conjunctivochalasis

Acta Ophthalmologica ◽

10.1111/aos.12425 ◽

2014 ◽

Vol 92 (7) ◽

pp. e592-e593 ◽

Cited By ~ 1

Author(s):

Sibel Kocabeyoglu ◽

Mehmet C. Mocan ◽

Murat Irkec

Keyword(s):

Ocular Surface ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Ocular Surface Disease ◽

Open Angle

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Ocular surface disease incidence in patients with open-angle glaucoma

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1608376r ◽

2016 ◽

Vol 144 (7-8) ◽

pp. 376-383

Author(s):

Marija Radenkovic ◽

Gordana Stankovic-Babic ◽

Predrag Jovanovic ◽

Jasmina Djordjevic-Jocic ◽

Marija Trenkic-Bozinovic

Keyword(s):

Dry Eye ◽

Ocular Surface ◽

Open Angle Glaucoma ◽

Disease Incidence ◽

Tear Film ◽

Ocular Surface Disease ◽

Delphi Panel ◽

Open Angle ◽

Pseudoexfoliative Glaucoma ◽

Film Instability

Introduction. Ocular surface disease (OSD) is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbances, tear film instability with potential damage to the ocular surface, accompanied by increased tear film osmolarity and inflammation of the ocular surface. It is a consequence of disrupted homeostasis of lacrimal functional unit. The main pathogenetic mechanism stems from tear hyperosmolarity and tear film instability. The etiological classification is hyposecretory (Sy-Sj?gren and non-Sj?gren) and evaporative (extrinsic and intrinsic) form. Delphi panel classification grades disease stages. Antiglaucoma topical therapy causes exacerbation or occurrence of symptoms of dry eye due to main ingredients or preservatives (benzalkonium chloride - BAK), which are dose- and time-dependent. BAK reduces the stability of the lipid layer of tears, the number of goblet cells, induces apoptosis and inflammatory infiltration. Objective. The aim of this study was the analysis of the OSD incidence in open-angle glaucoma patients caused by topical medicamentous therapy. Methods. Retrospective analysis of examined patients with open-angle glaucoma was used. Results. Increased incidence of moderate and advanced OSD Index degrees in the group of primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma. According to the Delphi Panel Scale the most common grade is IIb (POAG and pseudoexfoliative glaucoma). Evaporative form of OSD prevailed in all treatment groups. High percentage of dry eye in patients with higher concentrations of preservatives applied was noticed. Conclusion. OSD should be timely diagnosed and treated. Dry eye has an impact on surgical outcome and postoperative visual acuity, and in order to improve patient compliance and quality of life, symptoms of dry eye should be addressed and medications with lower concentrations of preservatives should be applied.

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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

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20173744 ◽

2017 ◽

Vol 6 (9) ◽

pp. 2199 ◽

Cited By ~ 2

Author(s):

Jayanthi C. R. ◽

Divyashree R. N. ◽

Sujatha B. L.

Keyword(s):

Ocular Surface ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Tertiary Care ◽

Ocular Surface Disease ◽

Care Hospital ◽

Open Angle ◽

Ocular Surface Disease Index ◽

Significant Difference ◽

Monitoring Treatment

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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Diagnosis and Treatment Methods for Ocular Surface Disease in Glaucoma

European Ophthalmic Review ◽

10.17925/eor.2014.08.01.40 ◽

2014 ◽

Vol 08 (01) ◽

pp. 40

Author(s):

Gemma C M Rossi ◽

Keyword(s):

Ocular Surface ◽

Diagnostic Tests ◽

Benzalkonium Chloride ◽

Tear Film ◽

Daily Practice ◽

Ocular Surface Disease ◽

Anterior Surface ◽

Treatment Methods ◽

Associated Diseases

Glaucoma and ocular surface disease (OSD) are often concomitant disorders (OSD is the consequence of a tear film dysfunction that may be due to several conditions). The aims of the paper are to suggest a sequence of diagnostic tests easy to perform in daily practice, both subjective and objective, to detect the onset of the OSD; and, second, to propose how to prevent and, if the case, how to manage the OSD. Briefly, tear film break-up time (TF-BUT) and corneal/conjunctival staining are suggested to detect the main signs of OSD. In terms of therapy, the long-term exposure to benzalkonium chloride (BAK) should be minimised, preferring non-BAK-preserved or BAK-free glaucoma medications, where available, as well as fixed combinations. The treatment of associated diseases of the anterior surface may reduce signs; use of non BAK-preserved tears may reduce symptoms.

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Ocular Surface Disease in Patients under Topical Treatment for Glaucoma

European Journal of Ophthalmology ◽

10.5301/ejo.5000977 ◽

2017 ◽

Vol 27 (6) ◽

pp. 694-704 ◽

Cited By ~ 13

Author(s):

Francisco Pérez-Bartolomé ◽

Jose M. Martínez-de-la-Casa ◽

Pedro Arriola-Villalobos ◽

Cristina Fernández-Pérez ◽

Vicente Polo ◽

...

Keyword(s):

Ocular Surface ◽

Treatment Duration ◽

Open Angle Glaucoma ◽

Tear Film ◽

Older Age ◽

Ocular Surface Disease ◽

Medication Group ◽

Pressure Lowering ◽

Tear Meniscus Height ◽

Corneal Staining

Purpose To examine the relationship between ocular surface disease (OSD) and topical antiglaucoma therapy. Methods A total of 211 eyes of 211 patients with open-angle glaucoma or ocular hypertension on topical medication were recruited over 10 months. Controls were 51 eyes of 51 healthy age- and sex-matched volunteers. In each patient, we recorded the intraocular pressure-lowering eyedrops used, the number of medications used, and daily and cumulative preservative concentrations (PC). Main outcome measures were fluorescein corneal staining score (Oxford scale), lower tear meniscus height (LTMH) (spectral-domain optical coherence tomography), noninvasive tear film breakup time (NI-TBUT) (Oculus Keratograph 5M), and OSD symptom questionnaire index (OSDI). Results Compared to controls, significantly higher OSDI (median [interquartile range] 10.24 [4.54-18.94] vs 2.5 [0-12.5]; p<0.001) and corneal staining (≥1: 64.93% vs 32.61%; p<0.001) scores were recorded in the medication group. The NI-TBUT and LTMH failed to vary between the groups (p>0.05). A higher daily PC was associated with a lower LTMH (R −0.142; p = 0.043). In the medication group, multivariate analysis identified correlations between benzalkonium chloride (BAK) (odds ratio [OR] 1.56) and BAK plus polyquaternium-containing drops (OR 5.09) or higher OSDI (OR 1.06) and abnormal corneal staining test results and between older age (mean ratio [MR] 1.05), longer treatment duration (MR 1.02), or corneal staining presence (MR 1.22) and a higher OSDI score. Conclusions Ocular surface disease was more prevalent in the medication group. The main factors impacting OSD were drops with preservatives, longer treatment duration, and older age.

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OCULAR SURFACE DISEASE AMONG PATIENTS WITH OPEN ANGLE GLAUCOMA USING TOPICAL ANTI-GLAUCOMA MEDICATIONS

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v6i6.4093 ◽

2021 ◽

Vol 71 (6) ◽

pp. 2041-44

Author(s):

Hassaan Javaid ◽

Omar Zafar ◽

Seemal Akram ◽

Sana Abbas ◽

Ikram Ullah Khan ◽

...

Keyword(s):

Ocular Surface ◽

Open Angle Glaucoma ◽

Tertiary Care ◽

Armed Forces ◽

Disease Index ◽

Ocular Surface Disease ◽

Common Finding ◽

P Value ◽

Open Angle ◽

Ocular Surface Disease Index

Objective: To determine the frequency of ocular surface disease among patients with open angle glaucoma using topical antiglaucoma medications presenting at a tertiary care eye hospital. Study Design: Cross-sectional analytical study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from May 2019 to Jan 2020. Methodology: One hundred and eighty patients aged 18 or more, with open angle glaucoma using any of the topical antiglaucoma medications including preparations of dorzolamide, brimonidine, timolol, levobunolol, betaxolol, latanoprost, travoprost, bimatoprost or a combination of these for more than six months took part in the study. Ocular surface disease index was used to assess the presence and severity of ocular surface disease. Results: Out of 180 patients of glaucoma managed with topical anti-glaucoma medications, 83 (46.1%) did not show presence of ocular surface disease when ocular surface disease index was administered. Twenty-nine (16.1%) patients had mild symptoms, 17 (9.4%) had moderate symptoms while 51 (28.3%) patients reported severe symptoms of ocular surface disease. Advancing age and longer duration of treatment with topical anti-glaucoma medications had statistically significant association with the presence of ocular surface disease (p-value <0.05). Conclusion: Presence of ocular surface disease was a common finding among patients using topical agents for the management of glaucoma. Advancing age and prolonged use of anti-glaucoma medication emerged as risk factors statistically related to the presence of ocular surface disease.

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The incidence of dry eye syndrome depending on the duration of antihypertensive drops use in patients with primary open-angle glaucoma

Reflection ◽

10.25276/2686-6986-2021-1-56-61 ◽

2021 ◽

Vol 11 (1) ◽

pp. 56-61

Author(s):

A.D. Pilipenko ◽

◽

R.A. Burya ◽

A.V. Romanova ◽

◽

...

Keyword(s):

Antihypertensive Therapy ◽

Dry Eye ◽

Ocular Surface ◽

Primary Open Angle Glaucoma ◽

Antihypertensive Drugs ◽

Open Angle Glaucoma ◽

Dry Eye Syndrome ◽

Open Angle ◽

Inclusion Criteria ◽

Systemic Pathology

Aim. To conduct a clinical assessment of the incidence of dry eye syndrome (DES) in patients with primary open-angle glaucoma (POAG), depending on the timing of the use of local antihypertensive therapy. Methods. The main group included 45 patients (45 eyes) with POAG. Inclusion criteria - use of local antihypertensive therapy for at least one month; absence of previous laser and microsurgery operations, systemic pathology that can cause DES (thyroid lesions, diabetes mellitus, autoimmune and rheumatoid diseases). The patients’ age averaged 61.2±8.7 years (from 47 to 82 years). There were 29 men and 16 women. The design of the work consisted of a comparative assessment of the frequency of DES formation in the studied groups and subgroups, as well as the degree of its severity. Results. The results of the study showed that with an increase in the duration of the use of local antihypertensive drugs by patients with POAG the incidence of DES development increases. Moderate changes in the studied functional parameters of the ocular surface were recorded as early as 1-3 years from the start of antihypertensive therapy. Especially often DES was formed in the 3rd subgroup and proceeded in more severe clinical forms. Conclusion. The initial statistically insignificant changes in the indicators of the state of the ocular surface in patients with POAG using local antihypertensive therapy took place at the time of their instillation from 1 to 3 years. Most often, according to our data, DES developed in patients with POAG after three years of using antihypertensive drugs (9 out of 15 patients). Key words: dry eye syndrome; glaucoma; antihypertensive therapy.

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