Ocular surface evaluation in patients treated with a fixed combination of prostaglandin analogues with 0.5% timolol maleate topical monotherapy: a randomized clinical trial

Abstract

OBJECTIVES:To compare ocular surface changes induced via glaucoma treatment in patients using fixed combinations of prostaglandin analogues (travoprost, latanoprost and bimatoprost) with 0.5% timolol maleateMETHODS:A prospective, multicenter, randomized, parallel group, single-blind clinical trial was performed in 33 patients with ocular hypertension or open angle glaucoma who had not been previously treated. The ocular surface was evaluated prior to and three months after treatment, with a daily drop instillation of one of the three medications. The main outcome measurements included the tear film break-up time, Schirmer's test, Lissamine green staining, the Ocular Surface Disease Index questionnaire, impression cytology using HE and PAS and immunocytochemistry for interleukin-6 and HLA-DR. Ensaiosclinicos.gov.br: UTN - U1111-1129-2872RESULTS:All of the drugs induced a significant reduction in intraocular pressure. Decreases in the Schirmer's test results were observed with all of the drugs. Decreases in tear-film break-up time were noted with travoprost/timolol and latanoprost/timolol. An increase in the Lissamine green score was noted with travoprost/timolol and bimatoprost/timolol. The Ocular Surface Disease Index score increased after treatment in the travoprost/timolol group. Impression cytology revealed a significant difference in cell-to-cell contact in the same group, an increase in cellularity in all of the groups and an increase in the number of goblet cells in all of the groups. The fixed combinations induced an increase in IL-6 expression in the travoprost/timolol group, in which there was also an increase in HLA-DR expression.CONCLUSIONS:All of the fixed combinations induced a significant reduction in intraocular pressure, and the travoprost/timolol group showed increased expression of the inflammatory markers HLA-DR and interleukin-6. All three tested medications resulted in some degree of deterioration in the ocular surface after three months of glaucoma treatment.

Topical cyclosporine to control ocular surface disease in patients with chronic glaucoma after long-term usage of topical ocular hypotensive medications

“…Topical hypotensive therapy with fixed combinations (prostaglandin analog and beta blocker eye drops) has been observed to increase the expression of the inflammatory markers HLA-DR and interleukin-6 with resultant deterioration in the ocular surface after three months of therapy. 27,28 The anti-inflammatory effect of topical cyclosporine 0.05% administered twice daily has been proven to be beneficial to reduce the inflammatory effects of mild to moderate dry eye disease. 15,20 Our study evaluated the concurrent effect of topical cyclosporine 0.05% therapy on the ocular surface in patients of long-term ocular hypotensives.…”

Ocular Surface Disease Index in Glaucomatous Patients Treated with Bimatoprost

“…Glaucoma is a chronic, multifactorial, progressive optic neuropathy that needs long-term treatment with topical hypotensive medications. Several classes of drugs are currently available to treat this condition, including notselective and selective beta-blockers, carbonic anhydrase inhibitor, prostaglandin (PG) and prostamide analogues as well as fixed combinations (Fcs) of prostaglandin/prostamide analogues combined with 0.50% timolol maleate [1]- [3]. In the Literature, there is also a bimatoprost formulated in DuraSite [4].…”