Kemer Özlem Evren, Mekala Priya, Dave Bhoomi, Kooner Karanjit Singh
Department of Ophthalmology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara 06800, Turkey.
Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Bioengineering (Basel). 2024 Oct 11;11(10):1010. doi: 10.3390/bioengineering11101010.
Ocular surface disease (OSD) is a frequent disabling challenge among patients with glaucoma who use benzalkonium chloride (BAK)-containing topical glaucoma medications for prolonged periods. In this comprehensive review, we evaluated the prevalence of OSD and its management, focusing on both current and future alternatives. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria were used to assess a) the impact of active ingredients and preservatives on the ocular surface and b) the efficacy of preservative-free (PF) alternatives and adjunctive therapies. BAK-containing glaucoma medications were found to significantly contribute to OSD by increasing corneal staining, reducing tear film stability, and elevating ocular surface disease index (OSDI) scores. Transitioning to PF formulations or those with less cytotoxic preservatives, such as Polyquad and SofZia, demonstrated a marked improvement in OSD symptoms. In particular, the use of adjunct cyclosporine A, through its anti-inflammatory and enhanced tear film stability actions, was shown to be very beneficial to the ocular surface. Therefore, the most effective management of OSD is multi-factorial, consisting of switching to PF or less cytotoxic medications, adjunct use of cyclosporine A, and early incorporation of glaucoma surgical treatments such as laser trabeculoplasty, trabeculectomy, glaucoma drainage devices, or minimally invasive glaucoma surgery (MIGS).
眼表疾病（OSD）是长期使用含苯扎氯铵（BAK）的局部青光眼药物的青光眼患者中常见的致残性问题。在这篇综述中，我们评估了OSD的患病率及其管理方法，重点关注当前和未来的替代方案。采用系统评价和Meta分析的首选报告项目（PRISMA）标准来评估：a）活性成分和防腐剂对眼表的影响；b）无防腐剂（PF）替代方案和辅助治疗的疗效。发现含BAK的青光眼药物通过增加角膜染色、降低泪膜稳定性和提高眼表疾病指数（OSDI）得分，对OSD有显著影响。改用PF制剂或含有细胞毒性较小的防腐剂（如Polyquad和SofZia）的制剂，可使OSD症状有明显改善。特别是，辅助使用环孢素A，通过其抗炎作用和增强泪膜稳定性的作用，对眼表非常有益。因此，OSD最有效的管理是多因素的，包括改用PF或细胞毒性较小的药物、辅助使用环孢素A，以及早期采用青光眼手术治疗，如激光小梁成形术、小梁切除术、青光眼引流装置或微创青光眼手术（MIGS）。
