Ruangvaravate Ngamkae, Choojun Karnthida, Srikulsasitorn Benjawan, Chokboonpiem Jatupol, Asanatong Dechathon, Trakanwitthayarak Supaporn
Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Clin Ophthalmol. 2020 Oct 7;14:3109-3119. doi: 10.2147/OPTH.S264984. eCollection 2020.
To study ocular surface disease (OSD) changes after switching from preserved prostaglandin analogues monotherapy to preserved tafluprost and preservative-free (PF) tafluprost in primary open-angle glaucoma patients.
Glaucoma patients treated with preserved prostaglandins (except tafluprost) monotherapy for at least 6 months, intraocular pressure (IOP) ≤22 mmHg, and diagnosed of OSD [≥1 criterion; tear break-up time (TBUT) ≤10 seconds, corneal fluorescein staining ≥grade 1] in both eyes were enrolled in a prospective, randomized, single-blinded study. All eligible patients were switched from preserved prostaglandin analogues monotherapy (latanoprost, bimatoprost, travoprost) to preserved tafluprost in one eye (group I) and PF-tafluprost in the other eye (group II) of the same patient by randomization. The symptoms of OSD were evaluated using the visual analogue scale, and lid inflammation, conjunctival hyperemia, TBUT, corneal fluorescein staining, and Schirmer I test were applied to assess the clinical signs. All parameters were evaluated before and then 6, 12, 24 weeks after switching the medications.
Thirty patients (80% women; mean age: 61.2 ±11.5 years) were included. Baseline parameters were not different between the treatment groups. After switching therapies, TBUT was significantly increased in both groups (p = 0.002, p = 0.004, respectively); however, group II had better tear quality. Other symptoms and clinical signs of OSD were improved and IOP was controlled in both groups.
Treatment with PF-tafluprost improves TBUT better than preserved tafluprost, suggesting that PF-tafluprost should be especially beneficial for patients with pre-existing OSD. Less or no preservative anti-glaucoma eye drops can restore and enhance the ocular surface in glaucoma patients.
研究原发性开角型青光眼患者从使用含防腐剂的前列腺素类似物单药治疗转换为使用含防腐剂的他氟前列素和不含防腐剂的他氟前列素后眼表疾病(OSD)的变化。
将使用含防腐剂的前列腺素(他氟前列素除外)单药治疗至少6个月、眼压(IOP)≤22 mmHg且双眼诊断为OSD[≥1条标准;泪膜破裂时间(TBUT)≤10秒、角膜荧光素染色≥1级]的青光眼患者纳入一项前瞻性、随机、单盲研究。所有符合条件的患者通过随机分组,将一只眼从含防腐剂的前列腺素类似物单药治疗(拉坦前列素、比马前列素、曲伏前列素)转换为含防腐剂的他氟前列素(I组),另一只眼转换为不含防腐剂的他氟前列素(II组)。使用视觉模拟量表评估OSD的症状,并应用睑缘炎症、结膜充血、TBUT、角膜荧光素染色和泪液分泌试验来评估临床体征。在换药前以及换药后6、12、24周对所有参数进行评估。
纳入30例患者(80%为女性;平均年龄:61.2±11.5岁)。治疗组之间的基线参数无差异。换药后,两组的TBUT均显著增加(分别为p = 0.002,p = 0.004);然而,II组的泪液质量更好。两组中OSD的其他症状和临床体征均得到改善,眼压得到控制。
使用不含防腐剂的他氟前列素治疗比使用含防腐剂的他氟前列素能更好地改善TBUT,这表明不含防腐剂的他氟前列素对已有OSD的患者可能特别有益。较少或不含防腐剂的抗青光眼滴眼液可恢复并增强青光眼患者的眼表。