Cover Image

Ocular Surface Evaluation After the Substitution of Benzalkonium Chloride Preserved Prostaglandin Eye Drops by a Preservative-free Prostaglandin Analogue

Nara Lidia Vieira LOPES, Carolina P. B. GRACITELLI, Maria Regina CHALITA, Nubia Vanessa dos Anjos Lima Henrique DE FARIA

Abstract


To evaluate ocular surface changes after withdrawal of Benzalkonium chloride (BAK) in patients with glaucoma in monotherapy with BAK-preserved prostaglandin. This was a prospective observational study. All patients underwent complete ophthalmologic examination and evaluation of ocular surface. A questionnaire was filled regarding symptoms of dry eye (Ocular Surface Disease Index [OSDI]) at the beginning of study. The treatment was switched to preservative-free tafluprost for 6 weeks and after this period, all patients were re-evaluated. All patients reported improvement of symptoms. The green lissamine test showed a significant improvement of the ocular surface, with most patients classified as light dry eye (P < 0.001). A significant improvement in the score (P < 0.001) was also found, with an average of 17.95 ± 5.35 points, which classifies the patients' symptoms in the normal to light zone. Benzalkonium chloride withdrawal reduced the signs and symptoms of dry eye in patients with primary open angle glaucoma (POAG).


References


WHO. Glaucoma is second leading cause of blindness globally Geneva: World Health Organization; 2011 [updated 2011-03-04 20:46:00]. Available from: http://www.who.int/bulletin/volumes/82/11/feature1104/en/.

Baudouin C, Pisella PJ, Fillacier K, Goldschild M, Becquet F, De Saint Jean M, et al. Ocular surface inflammatory changes induced by topical antiglaucoma drugs: human and animal studies. Ophthalmology. 1999;106(3):556-63. doi: 10.1016/S0161-6420(99)90116-1 pmid: 10080214

Pisella PJ, Debbasch C, Hamard P, Creuzot-Garcher C, Rat P, Brignole F, et al. Conjunctival proinflammatory and proapoptotic effects of latanoprost and preserved and unpreserved timolol: an ex vivo and in vitro study. Invest Ophthalmol Vis Sci. 2004;45(5):1360-8. pmid: 15111589

Rasmussen CA, Kaufman PL, Kiland JA. Benzalkonium chloride and glaucoma. J Ocul Pharmacol Ther. 2014;30(2-3):163-9. doi: 10.1089/jop.2013.0174 pmid: 24205938

Baudouin C, Labbé A, Liang H, Pauly A, Brignole-Baudouin F. Preservatives in eyedrops: the good, the bad and the ugly. Prog Retin Eye Res. 2010;29(4):312-34. doi: 10.1016/j.preteyeres.2010.03.001 pmid: 20302969

Iester M, Telani S, Frezzotti P, Motolese I, Figus M, Fogagnolo P, et al. Ocular surface changes in glaucomatous patients treated with and without preservatives beta-blockers. J Ocul Pharmacol Ther. 2014;30(6):476-81. doi: 10.1089/jop.2013.0216 pmid: 24787056

Pisella PJ, Pouliquen P, Baudouin C. Prevalence of ocular symptoms and signs with preserved and preservative free glaucoma medication. Br J Ophthalmol. 2002;86(4):418-23. pmid: 11914211

Stewart WC, Stewart JA, Nelson LA. Ocular surface disease in patients with ocular hypertension and glaucoma. Curr Eye Res. 2011;36(5):391-8. doi: 10.3109/02713683.2011.562340 pmid: 21501071

The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007;5(2):75-92. pmid: 17508116

van Bijsterveld OP. Diagnostic tests in the Sicca syndrome. Arch Ophthalmol. 1969;82(1):10-4. pmid: 4183019

Savini G, Prabhawasat P, Kojima T, Grueterich M, Espana E, Goto E. The challenge of dry eye diagnosis. Clin Ophthalmol. 2008;2(1):31-55. pmid: 19668387

Baffa Ldo P, Ricardo JR, Dias AC, Modulo CM, Braz AM, Paula JS, et al. Tear film and ocular surface alterations in chronic users of antiglaucoma medications. Arq Bras Oftalmol. 2008;71(1):18-21. pmid: 18408831

Noecker R. Effects of common ophthalmic preservatives on ocular health. Adv Ther. 2001;18(5):205-15. pmid: 11783457

Herrero-Vanrell R, Peral A. [International Dry Eye Workshop (DEWS). Update of the disease]. Arch Soc Esp Oftalmol. 2007;82(12):733-4. pmid: 18040913

Jaenen N, Baudouin C, Pouliquen P, Manni G, Figueiredo A, Zeyen T. Ocular symptoms and signs with preserved and preservative-free glaucoma medications. Eur J Ophthalmol. 2007;17(3):341-9. pmid: 17534814

Rossi GC, Tinelli C, Pasinetti GM, Milano G, Bianchi PE. Dry eye syndrome-related quality of life in glaucoma patients. Eur J Ophthalmol. 2009;19(4):572-9. pmid: 19551671

Cvenkel B, Štunf Š, Srebotnik Kirbiš I, Strojan Fležar M. Symptoms and signs of ocular surface disease related to topical medication in patients with glaucoma. Clin Ophthalmol. 2015;9:625-31. doi: 10.2147/OPTH.S81247 pmid: 25914521

Van Went C, Alalwani H, Brasnu E, Pham J, Hamard P, Baudouin C, et al. [Corneal sensitivity in patients treated medically for glaucoma or ocular hypertension]. J Fr Ophtalmol. 2011;34(10):684-90. doi: 10.1016/j.jfo.2011.07.011 pmid: 22093372

Baffa LoP, Ricardo JR, Dias AC, Módulo CM, Braz AM, Paula JS, et al. Tear film and ocular surface alterations in chronic users of antiglaucoma medications. Arq Bras Oftalmol. 2008;71(1):18-21. pmid: 18408831

Uusitalo H, Egorov E, Kaarniranta K, Astakhov Y, Ropo A. Benefits of switching from latanoprost to preservative-free tafluprost eye drops: a meta-analysis of two Phase IIIb clinical trials. Clin Ophthalmol. 2016;10:445-54. doi: 10.2147/OPTH.S91402 pmid: 27041987

Nichols KK, Nichols JJ, Mitchell GL. The lack of association between signs and symptoms in patients with dry eye disease. Cornea. 2004;23(8):762-70. pmid: 15502475

Fechtner RD, Godfrey DG, Budenz D, Stewart JA, Stewart WC, Jasek MC. Prevalence of ocular surface complaints in patients with glaucoma using topical intraocular pressure-lowering medications. Cornea. 2010;29(6):618-21. doi: 10.1097/ICO.0b013e3181c325b2 pmid: 20386433


Full Text: Full Text PDF

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.