Clinical and morphological evidence of the effect of preservatives on the eye surface in primary open-angle glaucoma

PURPOSE: To compare clinical features related to changes in the eye surface caused by long term use of prostaglandin antiglaucoma agents, containing and not containing preservatives, and to perform comparative morphological analysis of the conjunctival biopsies in the study groups. METHODS: The study was performed on 90 patients aged 36 to 89 years (mean age 64.5±11.3 years), including 36 males and 54 females. The first two groups were comprised of the patients with newly diagnosed primary open-angle glaucoma stage 1-3, who were prescribed Taflotan without preservatives produced by «Santen» (tafluprost 0.0015% solution in single use 0.3 ml dripping tubes) (1st group) and 0.005% latanoprost with 0.02% benzalkonium chloride or 0.004% travoprost with 0.015% benzalkonium chloride (2nd group). Mean duration of treatment within the frameworks of the study was 135 days, minimal - 90 days. The control group included patients with age-related cataract of various degree of maturation who did not receive local treatment. In the beginning and the end of the study, all patients underwent assessment of the eye surface condition for Dry Eye Syndrome (DES), including symptom scope according to the OSDI (Ocular Surface Disease Index); assessment of the conjunctival folds degree (LIPCOF); the tear film rapture time (TFRT); the degree of Rose Bengal staining of the eye surface (RB); and Schirmer 1 test. At the end of the study selective biopsies were performed during the surgery. RESULTS: Statistically significant gender differences in DES incidence were revealed: 78% of females (42/54) versus 39% of males (14/36). At the end of the study statistically significant decrease in OSDI score in both groups was revealed, compared to baseline data without differences between the groups, as well as Schirmer 1 test in the second group. Treatment complications (hyperemia, subcompensated intraocular pressure, DES and cataract progression) were noted in 3 eyes in the first group, and 11 eyes in the second group (the difference was statistically significant). Hyperemia was revealed in 6% (2 eyes) and 17% (6 eyes), in the first and second group, respectively. In the second group DES progression was revealed, showing correlation with decreased tear expression during Schirmer 1 test. CONCLUSION: Tafluprost without preservatives is an effective and safe hypotensive agent from the group of prostaglandin analogues. It is better tolerated, causes least complaints during instillation, and less adverse effects in the long term use (hyperemia, advancement of the preexisting Dry Eye Syndrome, etc.) when compared to other medications from the same pharmacologic group containing preservatives, which is confirmed by comparative morphological assessment of conjunctiva biopsies.

тафлупрост, простагландины, бензалкония хлорид, конъюнктива, поверхность глаза, глаукома, морфология, tafluprost, prostaglandins, benzalkonium chloride, conjunctiva, eye surface, glaucoma, morphology

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