Abstract
Background: Ocular surface frequently affects glaucoma patients. In this paper we aimed at evaluating the impact of glaucoma surgery on the ocular surface of patients who received unilateral trabeculectomy. Methods: 26 consecutive patients successfully treated with trabeculectomy on one eye (Trab Eye) and under control with topical treatments on the fellow eye (Med Eye) were included in this observational study. They received IDEEL and OSDI questionnaires, Tear Film Osmolarity (TFO), grading of conjunctival hyperemia, fluorescein tear break-up time (tBUT), grading of corneal staining and Schirmer test. Results: IDEEL and OSDI scores were 48 ± 38 and 11 ± 12, respectively, with moderate correlation (r = 0.50, p = 0.03). Compared with Med eyes, Trab Eyes had higher tBUT (6.5 ± 3.5 vs. 5.1 ± 2.7 s, p = 0.004), lower conjunctival hyperemia (0.8 ± 0.9 and 1.7 ± 1.1 respectively, p < 0.001) and lower corneal staining (0.3 ± 0.5 and 0.6 ± 0.5, respectively, p = 0.03). Correlation between corneal staining and conjunctival hyperemia was 0.55 in Trab Eyes (p = 0.01) and 0.44 in Med Eyes (p > 0.05). Patients with bilateral corneal staining had had threefold worse questionnaire scores (p < 0.05). The duration of treatment and the daily exposure to preservatives did not directly affect OS parameters in this cohort of patients. Conclusions: Patients receiving successful trabeculectomy showed better OS homeostasis (higher TBUT, lower grading of conjunctival hyperemia and corneal staining) than fellow medically treated eyes. Presence of corneal epithelial damage in both eyes is the factor more consistently affecting questionnaire scores.
Highlights
Glaucoma is the leading cause of irreversible blindness with more than 70 million people affected worldwide [1]
More than 38% of glaucoma patients treated with just one eye drop have ocular surface disease, and the incidence increases with the number of medications used [4,5]
26 consecutive patients with an history of trabeculectomy with complete success on one eye and receiving intraocular pressure (IOP)-lowering treatments just on the fellow eye were included in this study
Summary
Glaucoma is the leading cause of irreversible blindness with more than 70 million people affected worldwide [1]. Benzalkonium chloride (BAK) is the most used preservative in glaucoma eyedrops as it is effective in preventing microbial contamination Still, it breaks up the tight junctions increasing the space between epithelial cells; it increases oxidation due to mitochondrial depolarization, cytochrome c release and augmentation in caspases activity, which all negatively impact on the homeostasis of corneal epithelial cells, conjunctival goblet cells, and sub-basal nerve plexus [7]. Methods: 26 consecutive patients successfully treated with trabeculectomy on one eye (Trab Eye) and under control with topical treatments on the fellow eye (Med Eye) were included in this observational study They received IDEEL and OSDI questionnaires, Tear Film Osmolarity (TFO), grading of conjunctival hyperemia, fluorescein tear break-up time (tBUT), grading of corneal staining and Schirmer test. Presence of corneal epithelial damage in both eyes is the factor more consistently affecting questionnaire scores
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