Frequency of Dry Eye in Glaucoma Patients Using Topical Anti-Glaucoma Therapy

Aim: To determine the prevalence of dry eye in glaucoma patients using topical anti-glaucoma therapy. Study Design: Descriptive observational study Place and duration of study: Department of Ophthalmology, Shalimar Medical & Dental College Lahore from 1st November 2020 to 30th April 2021. Methodology: Ninety patients of both genders were enrolled. Detailed demographics of enrolled cases age, sex and body mass index were recorded after taking informed written consent. Patients using topical anti-glaucoma therapy for more than 8 months and having symptoms of stinging and burning sensations itching, watering, irritation, due to regular use of topical antiglaucoma drugs were presented. Basal Schrimer’s test and tear film break-up time test was used to measure the frequency of dry eye syndrome as mild, moderate and severe. Results: There were 60 (66.7%) females and 30 (33.3%) patients were males. Mean age of the patients were 45.61±7.66 years with mean BMI 26.24±8.71 kg/m2. We found that 40 (44.4%) patients had burning and stinging sensations, itching found in 21 (23.3%), dry eye sensations were found in 16 (17.8%) patients and watering and irritation found in 13 (14.4%) .According to tear film break-up time test 20 (22.2%) cases did not show dry eye syndrome and 19 (21.1%) patients were normal in Basal Schrimer’s test. Conclusion: Use of topical anti-glaucoma medication resulted in dry eye syndrome as well as a decrease in the tear film's stability. Keywords: Anti-glaucoma therapy, Basal Schrimer`s test, Tear film break-up time, Anti-glaucoma therapy, Dry eye syndrome

New Opportunities in Non-Preservative Glaucoma Therapy

Most of the medicines used for the treatment of glaucoma include a preservative in various concentrations. With long-term topical therapy, patients with glaucoma may develop dry eye syndrome (DES). The severity of symptoms depends on the number of drugs used and the presence of a preservative in them. Against the background of DES progression, compliance to glaucoma therapy may decrease, and, consequently, the effectiveness of the treatment may decrease. Currently, new non-preservative hypotensive drugs containing brimonidine, as well as a fixed combination (FC) of dorzolamide and timolol, are available on the market.Purpose: to compare assessment of the hypotensive effect and tolerability of preservative-free drugs FC Dorzolamid 20 mg/ml, Timolol 5 mg/ml (Dortmol Antiglau ECO) and Brimonidine 2 mg/ml (Brim Antiglau ECO) when switching from similar drugs containing a preservative in patients with compensated glaucoma.Patients and methods. In this prospective clinical study, 60 patients (60 eyes) with compensated primary open-angle glaucoma on combined topical therapy were examined. In group 1 (30 patients, 30 eyes), the combinations of dorzolamide / timolol or brinzolamide / timolol were switched with the non-preservative Dortmol Antiglau ECO. In group 2 (30 patients, 30 eyes), the brimonidine as part of the medication regimen were replaced with the non-preservative Brim Antiglau ECO. The level of corneal-compensated IOP was assessed before the switch in therapy and after 1 month. Subjective feelings and objective signs of the treatment’s use were monitored during examination and using a questionnaire, which was compiled to study the tolerance of therapy.Results. Switching to a preservative-free combination of dorzolamide and timolol resulted in a reduction in complaints of irritation, lacrimation, and foreign body sensation. The efficiency control did not reveal a significant change (p > 0.05) in the cornealcompensated intraocular pressure (IOPcc). When transferred to the Brim Antiglau ECO as part of the local hypotensive treatment, intraocular pressure decreased significantly (p < 0.05). The average total score characterizing drug intolerance, when evaluated by the patient, decreased by 2.4 times, by the attending physician-by 1.9 times. The degree of conjunctival hyperemia on the MacMonnies photographic scale decreased in both groups.Conclusion. Preservative-free drugs can be recommended for most patients with glaucoma as a starting treatment and as a replacement for current therapy.

Trickle Down Effects of Covid-19 on Glaucoma Patients

Purpose: To report the adherence of Glaucoma patients to anti-glaucoma medical therapy during lockdown period of covid-19 and to evaluate the factors that lead to non-adherence to medical therapy. Study Design: Cross sectional survey. Place and Duration of Study: Al-Shifa Trust Eye Hospital, Rawalpindi from August 2020 to October 2020. Methods: A total of 210 patients diagnosed with glaucoma were included. Exclusion criteria was newly diagnosed cases of glaucoma and patients who were non-compliant before lockdown. Patients’ age, gender, marital status, occupation, residence, monthly income bracket, type of glaucoma, duration of glaucoma, number and type of anti-glaucoma medication and any other co-morbidity like diabetes or hypertension were asked from the patient. The patients were evaluated for best corrected visual acuity (BCVA), intraocular pressure (IOP) and retinal nerve fiber layer thickness (RNFL). Before lockdown, BCVA, IOP and RNFL thickness were taken from computerized data of our hospital. Patients were asked about the compliance of the anti-glaucoma therapy and the factors that lead to non-compliance (if any). Results: Out of 210 individuals, there were 131 (62.4%) males and 79 (37.6%) females. About 169 (80.5%) patients reported non-compliance to anti-glaucoma drugs during the lockdown period. Non-availability of medicines was the most common reason given by 77 (57.5%) individuals, followed by lack of money by 44 (32.8%) patients. Conclusion: A high proportion of non-compliance to anti-glaucoma therapy was seen in glaucoma patients during pandemic. Low literacy rate, non-availability of medicines and lack of money were major reasons for non-compliance. Key Words: Covid-19, Glaucoma, Intra ocular Pressure.

Distribution of Gold Nanoparticles in the Anterior Chamber of the Eye after Intracameral Injection for Glaucoma Therapy

In glaucoma therapy, nanoparticles (NPs) are a favorable tool for delivering drugs to the outflow tissues of the anterior chamber of the eye where disease development and progression take place. In this context, a prerequisite is an efficient enrichment of NPs in the trabecular meshwork with minimal accumulation in off-target tissues such as the cornea, lens, iris and ciliary body. We evaluated the optimal size for targeting the trabecular meshwork by using gold NPs of 5, 60, 80 and 120 nm with a bare surface (AuNPs) or coated with hyaluronic acid (HA-AuNPs). NPs were compared regarding their colloidal stability, distribution in the anterior chamber of the eye ex vivo and cellular uptake in vitro. HA-AuNPs demonstrated an exceptional colloidal stability. Even after application into porcine eyes ex vivo, the HA coating prevented an aggregation of NPs inside the trabecular meshwork. NPs with a diameter of 120 nm exhibited the highest volume-based accumulation in the trabecular meshwork. Off-target tissues in the anterior chamber demonstrated an exceptionally low gold content. Our findings are particularly important for NPs with encapsulated anti-glaucoma drugs because a higher particle volume would be accompanied by a higher drug payload.