Abstract
Purpose: A pilot study to determine whether topical prostaglandin analogues alter the expression of conjunctival inflammatory markers in patients with uveitic glaucoma.Methods: Prospective, single-masked case series of 20 patients with uveitis and secondary raised intraocular pressure. Participants were divided into four groups of five patients dependent on their use of topical medication: (1) prostaglandin analogues only, (2) corticosteroids only, (3) both prostaglandin analogues and corticosteroids, (4) no topical medication. Conjunctival cells were harvested by impression cytology and were examined for inflammatory markers (CD3, CD54, HLA-DR, CCR4, CCR5) by flow cytometry. A tear fluid sample was also examined for inflammatory cytokines (IL-12p70, IL-2, IL-10, IL-8, IL-6, IL-4, IL-5, IFN-gamma, IL-1beta, IFN-alpha, IFN-beta) by multiplex bead arrays.Results: All groups demonstrated increased markers of conjunctival inflammation. There was no significant difference in levels of any inflammatory markers between the four groups, suggesting that the use of topical prostaglandin analogues does not increase conjunctival levels of inflammation beyond those already seen in uveitis.Conclusions: The use of topical prostaglandins does not appear to induce conjunctival inflammation over that which is already present in patients with uveitic glaucoma. This supports the use of topical prostaglandin analogues in patients with uveitic glaucoma, indicating that their use is unlikely to adversely affect subsequent glaucoma filtration surgery through the induction of chronic conjunctival inflammation.
Highlights
Secondary glaucoma is seen in about 10-20% of patients attending a uveitis clinic and occurs in combination with all types of uveitis [1,2,3,4]
*Address correspondence to this author at the Imperial College London Faculty of Medicine, Room 5N8B, 5th Floor Commonwealth Building, Hammersmith Hospital, London W12 0NN, UK; Tel: +44 (0) 20 8383 2306; Fax: +44 (0) 20 7566 2266; E-mail: s.r.taylor@imperial.ac.uk and cause conjunctival side-effects including hyperaemia, in 10-60% of cases [8, 9, 11,12,13,14]. The purpose of this pilot study was to address the effects of prostaglandin analogues on the expression of inflammatory markers on the conjunctival epithelium and tear film in patients who suffer from uveitis, in order to determine whether these drugs are likely to adversely prejudice subsequent trabeculectomy surgery in this group
All of the inflammatory markers measured (CD3, CD54, HLADR, CCR4 and CCR5) were found to be increased above normal levels in all of the groups, but there was no significant difference in the levels seen between any of the groups (Fig. 1), suggesting that neither topical prostaglandins nor topical corticosteroids have a significant additional effect on conjunctival surface markers of inflammation in patients with uveitis
Summary
Secondary glaucoma is seen in about 10-20% of patients attending a uveitis clinic and occurs in combination with all types of uveitis [1,2,3,4]. The prostaglandin analogues are a group of compounds that have become the most frequently used ocular hypotensive drugs owing to their efficiency in reducing intraocular pressure and the low incidence rate and severity of adverse events, in particular in the absence of systemic side effects, especially in comparison to the beta-blockers [810] They are pro-inflammatory, at least in theory, The purpose of this pilot study was to address the effects of prostaglandin analogues on the expression of inflammatory markers on the conjunctival epithelium and tear film in patients who suffer from uveitis, in order to determine whether these drugs are likely to adversely prejudice subsequent trabeculectomy surgery in this group
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