Possibilities of Preservative-Free Therapy for Primary Open-Angle Glaucoma

Abstract

Purpose: To compare the effectiveness of trabeculectomy and evaluate the change of the state of the tissues of the anterior segment of the eye in patients with long-term use of preservative and non-preserved hypotensive therapy before surgery. Patients and Methods. The study was conducted in a group of 30 patients (30 eyes) aged from 58 to 77 years with uncompensated primary openangle glaucoma, who were admitted to the glaucoma surgery. The patients were divided into 2 groups depending on the hypotensive regimen used before surgery: group I - patients who used preservative-containing local hypotensive drugs; Group II - patients who used Traviolan© and other non-preservative hypotensive drugs before antiglaucoma surgery. At the initial examination, the collection and analysis of patient complaints, visometry, tonometry, and biomicroscopy of the structures of the anterior segment of the eye were performed. Patients complaints were assessed on the OSDI test questionnaire. The study of total tear production was investigated using the Schirmer test. The tear film break time study investigated the Norn test. Observation and re-examinations were performed a week, 1 month and 3 months after trabeculectomy. Results. A week after glaucoma surgery, there was a short-term deterioration in the parameters by which dry eye disease (DED) was assessed: in group I, OSDI was 11.8 ± 3.3, Schirmer and Norn tests — 5.3 ± 1.3 mm and 4.3 ± 1.0 sec, respectively. In group II OSDI was 10.7 ± 3.5, Schirmer and Norn tests were 8.2 ± 2.2 mm and 4.7 ± 1.3 sec, respectively. After 1 and 3 months, the DED indicators improved, more pronounced in group I: after 1 and 3 months, OSDI was 12.9 ± 3.7 and 12.9 ± 4.2, respectively; Schirmer’s test — respectively, 7.4 ± 1.9 and 7.0 ± 1.8 mm; Norn’s test — 5.1 ± 0.8 and 5.2 ± 0.9 sec. In group II, 1 and 3 months after trabeculectomy, OSDI was 12.4 ± 3.0 and 12.4 ± 2.4. Schirmer’s test was 9.9 ± 2.1 and 9.5 ± 1.7 mm, Norn’s test was 5.5 ± 1.2 and 5.5 ± 1.3 sec, respectively. At all follow-up periods, except for week 1, there was a significant intergroup difference between the studied parameters of dry eye disease (p < 0.05). Conclusion. Long-term use of preservative-containing hypotensive therapy contributes to the development of chronic toxic-allergic conjunctivitis, which affects the long-term prognosis of trabeculectomy and the quality of life associated with DED. One of the ways to minimize such negative effects is the use of preservative-free drugs in the selection of glaucoma therapy. The use of a preservative-free form of travoprost is justified due to its high selectivity for FP-prostanoid receptors, which ensures high efficiency and less side effects. The improvement in DED parameters associated with cancel of therapy after surgery is more pronounced in the group of patients who initially took preservative-free drugs.