Comparison between therapeutic effects of 0.18% sodium hyaluronate and 1% carboxymethyl cellulose on ocular surface damage induced by anti-glaucoma medications

Abstract

Purpose This study was conducted to compare the therapeutic effect of 1% carboxymethyl cellulose (CMC) and 0.18% sodium hyaluronate (SH) on ocular surface damage induced by various anti-glaucoma medications. Patients and methods The study included 100 patients who were diagnosed as having primary open-angle glaucoma, normal tension glaucoma, or ocular hypertension and were on anti-glaucoma drugs. The patients were divided in two groups: group A patients received 1% CMC, whereas group B patients received 0.18% SH for 3 months. The severity of ocular surface disease symptoms was assessed by the ocular surface disease index (OSDI) questionnaire. Ocular examination with tear film break-up time, fluorescein staining, Schirmer’s test, and conjunctival impression cytology was performed sequentially on days 0, 30, and 90. Results Both CMC-treated and SH-treated groups showed improvement in the OSDI scores at days 30 and 90. However, the OSDI scoring was statistically significantly better in the SH group at both follow-up intervals (P<0.05). Fluorescein staining improved significantly with SH compared with CMC at day 30 (P<0.03). Schirmer’s test, tear film break-up time, and conjunctival impression cytology improved in both drugs. However, the difference was not statistically significant (P>0.5). Conclusion Both SH and CMC improved the symptoms and signs of ocular surface damage caused by the preservatives used in anti-glaucoma medication. However, SH showed faster efficacy than the CMC-based formulation.