Tear replacement by cationic emulsion in complex therapy of superficial punctate keratitis in hypotensively medicated glaucoma patients

Purpose. To evaluate the efficacy of lubricating cationic emulsion in the combined treatment of superficial punctate keratitis (SPK) of glaucoma patients. Material and methods. The clinical study involved an experimental group 1 of 28 patients (30 eyes) aged 50 to 84 (mean age 67.1 ± 7.2 years) with symptoms of SPK who received long-term (averagely 9.5 ± 6.6 years) topical hypotensive anti-glaucoma medication. The control group 2 consisted of 26 patients (mean age 67.6 ± 7.1 years) belonging to the experimental group: in this case, the contralateral eyes with topical anti glaucoma medication but no signs of keratitis were examined. The basic therapy for group 1 consisted of topical antihistamine, corneoprotector (dexpanthenol) and a new generation lubricant, Cationorm. Group 2 was also treated with Cationorm. The testing procedures and efficiency monitoring included biomicroscopy, Schirmer test, Norn test and evaluation of tear film osmolarity. Results. Dry eye symptoms with disturbed tear film osmolarity and decreased values of Norn and Schirmer tests were detected in all patients both in the eyes with SPK manifestations and without them. Patients with concomitant dry eye syndrome who received complex therapy, including Cationorm, showed increased tear film stability: Norn sample values increased from 5.5 ± 1.8 to 8.5 ± 2.1 seconds and from 7.7 ± 1.4 to 8.8 ± 2.2 seconds in groups 1 and 2, respectively, p < 0.05). Besides, the values of the Schirmer test improved from 6.3 ± 2.1 to 8.3 ± 3.7 mm and 8.7 ± 3.7 to 9.1 ± 3.8 mm in groups 1 and 2, respectively, p < 0.05), and osmolarityrate decreased in both groups, p < 0.05. Subjective symptoms in group 1 changed from 3.4 to 0.6 points after 3 months of treatment. The average severity of SPK, which amounted to 4.2 ± 2.3 points before treatment, dropped to 1.2 ± 0.9, 0.23 ± 0.5 and 0.1 ± 0.3 points respectively after 1, 2 and 3 months. Conclusion. The study shows that Cationorm can be considered as a tear replacement lubricant of choice in the complex therapy of superficial punctate keratitis and dry eye symptoms in chronically medicated glaucoma patients // Russian Ophthalmological Journal, 2016; 4: 52-7. doi: 10.21516/2072-0076-2016-9-4-52-57.

поверхностный точечный кератит, синдром «сухого глаза», глаукома, консерванты, тест Ширмера, проба Норна, осмолярометрия, кератопротекторы, слезозаместительная терапия, Катионорм, superficial punctate keratitis, dry eye syndrome, glaucoma, preservatives, Schirmer test, Norn test, tear film osmolarity, Cationorm

1. Marquis R.E., Whitson J.T. Management of glaucoma: focus on pharmacological therapy. Drugs and Aging. 2005; 22(1): 1-21.

2. Camras C.B., Toris C.B., Tamesis R.R. Efficacy and adverse effects of medications used in the treatment of glaucoma. Drugs and Aging, 1999; 15(5): 377-88.

3. Сафонова Т.Н., Федоров А.А., Забегайло А.О., Егорова Г.Б., Митичкина Т.С. Лечение синдрома «сухого глаза» при первичной глаукоме. Национальный журнал глаукома. 2015; 14 (4): 36-43.

4. De Saint Jean M., Debbasch C., Brignole F., et al. Toxicity of preserved and unpreserved antiglaucoma topical drugs in an in vitro model of conjunctival cells. Curr Eye Res. 2000; 20: 85-94.

5. Burstein N.L. Corneal cytotoxicity of topically applied drugs, vehicles and preservatives. Surv Ophthalmol. 1980; 25: 15-30.

6. Burstein N.L. The effects of topical drugs and preservatives on the tears and corneal epithelium in dry eye. Trans Ophthalmol Soc UK. 1985; 104: 402-9.

7. Егорова Г.Б., Федоров А.А., Митичкина Т.С., Шамсутдинова А.Р., Сафонова Т.Н. Влияние слезозаместительной и корнеопротекторной терапии на состояние глазной поверхности при синдроме «сухого глаза». Клиническая Офтальмология. 2015; 15(1): 15-21.

8. Wilcon L.A. To preserve or not to preserve, is that the question? Br. J. Ophthalmol. 1996; 80: 583-4.

9. Baudouin C., Labbé A., Liang H., Pauly A., Brignole-Baudouin F. Preservatives in eyedrops: the good, the bad and the ugly. Prog. Retin. Eye Res. 2010; 29: 312-34.

10. Fechtner R.D., Godfrey D.G., Budenz D., et al. Prevalence of ocular surface complaints in patients with glaucoma using topical intraocular pressure-lowering medications. Cornea 2010; 29: 618-21.

11. Friedman N.J. Impact of dry eye disease and treatment on quality of life. Current Opinion in Ophthalmology. 2010; 21(4): 310-6.

12. Noecker R.J., Herrygers L.A., Anwaruddin R. Corneal and conjunctival changes caused by commonly used glaucoma medications. Cornea. 2004; 23: 490-6.

13. Becquet F., Goldschild M., Moldovan M.S., et al. Histopathological effects of topical ophthalmic preservatives on rat corneoconjunctival surface. Curr Eye Res. 1998; 17: 419-25.

14. Wilson F.M. Adverse external ocular effects of topical ophthalmic medications. Surv Ophthalmol. 1979; 24: 57-88.

15. Yalvac I.S., Gedikoglu G., Yaragöz Y., et al. Effects of antiglaucoma drugs on ocular surface. Acta Ophthalmol Scand. 1995; 73: 246-8.

16. Herreras J.M., Pastor J.C., Calonge M., et al. Ocular surface alteration after long-term treatment with an antiglaucomatous drug. Ophthalmology. 1992; 99: 1082-8.

17. Burstein N.L. Preservative cytotoxic threshold for benzalkonium chloride and Chlorhexidine digluconate in cat and rabbit corneas. Invest. Ophthalmol. Vis Sci. 1980; 19: 308-13.

18. Grant R.L., Acosta D. Prolonged adverse effects of benzalkonium chloride and sodium dodecyl sulfate in a primary culture system of rabbit corneal epithelial cells. Fundam Appl Toxicol. 1996; 33: 71-82.

19. De Jong C., Solwijk T., Kuppens E., et al. Topical timolol with and without benzalkonium chloride; epithelial permeability and autofluorescence of the cornea in glaucoma. Graefes Arch. Clin. Exp. Ophthalmol. 1994; 232: 221-4.

20. Servat J.J., Bernardino C.R. Effects of common topical antiglaucoma medications on the ocular surface, eyelids and periorbital tissue. Drugs Aging 2011; 28: 267-282.

21. Pisella P.J., Pouloquen P., Baudouin C. Prevalence of ocular symptoms and signs with preserved and preservative free glaucoma medication. Br. J. Ophthalmol. 2002; 86: 418-23.

22. Bohn R.L., Gurwitz J.H., Yeomans S.M., et al. Which patients are treated for glaucoma? An observational analysis. J. Glaucoma. 2000; 9: 38-44.

23. Gordon J., Johnson P.J. Fibronectin Study Group-discontinuation of topical ophthalmic medications promotes healing of non-healing corneal epithelial defects. Invest. Ophthalmol. Vis Sci. 1991; 32:.1071.

24. Laflamme M.Y., Swieca R. A comparative study of two preservative-free tear substitutes in the management of severe dry eye. Can. J. Ophthalmol. 1988; 23: 174-6.

25. Miyata K., Amano S., Sawa M., Nishida T. A novel grading methods for superficial punctate keratopathy magnitude and its correlation with corneal epithelial permeability. Arch. Ophthalmol. 2003; 121(11): 1537-9.

26. Baudouin C., Renard J.-P.l, Nordmann J.-P., et al. Prevalence and risk factors for ocular surface disease among patients treated over the long term for glaucoma or ocular hypertension. Eur. J. Ophthalmol. 2013; 23(1): 47-54.

27. Edelhauser H.F., Ubels J. The cornea and the sclera. In: Kaufman P.L., Alm A., eds. Adler’s Physiology of the Eye. 10th ed. St. Louis, MO: Mosby; 2003: 47-114.