March 01, 2019
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Treating OSD may help reduce IOP in advanced glaucoma

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Treating ocular surface disease in patients with glaucoma may improve IOP control and reduce the need for filtering surgery, according to a study.

At the Quinze-Vingts National Ophthalmology Hospital in Paris, 10 patients presenting for filtration surgery for uncontrolled primary open-angle glaucoma (POAG) were treated for concomitant ocular surface disease (OSD).

All treatments, including the main glaucoma treatment, lubricants and other drops potentially causing side effects, were swapped out with preservative-free alternatives with a better safety profile. Lid hygiene was regularly performed and, when necessary, anti-inflammatory agents such as cyclosporine or NSAIDs were administered. Brimonidine, which appeared to have played an important role in this group of patients, was discontinued.

After 3 months on the new regimen, mean IOP had significantly decreased from 23.75+9.98 mm Hg to 15.5+4.75 mm Hg. The mean number of IOP-lowering drops had also decreased significantly by almost one drop. Results were stable at 1 year. All patients showed ocular surface improvement, and eight out of 10 were able to avoid surgery.

The prevalence of OSD in glaucoma patients on multiple glaucoma medications is high and can be, in itself, a cause of uncontrolled IOP and glaucoma progression. The authors hypothesized as potential causes the direct toxicity of drugs to the trabecular meshwork, the diffusion in the deep tissue of inflammatory mediators, chronic vasodilation and consequent outflow resistance through the episcleral venous network. Vasodilation may also accelerate the washout of eye drops, making them less effective.

“Overall, these data encourage us to further consider the ocular surface of our patients in medical therapy failure before performing filtrating surgery,” the authors wrote.

They also emphasized that a subtractive and conservative approach to the ocular surface is sometimes more suitable than an additive and potentially iatrogenic approach.

“Careful management of the ocular surface associated with a reduction of the toxicity of eyedrops may result in improvement of ocular surface health and better IOP control,” they concluded. – by Michela Cimberle

Disclosure: The authors reported no relevant financial disclosures.