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      Decreased keratocyte density and central corneal thickness in primary open-angle glaucoma patients undergoing treatment with topical prostaglandin analogues

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          Abstract

          Purpose:

          To evaluate whether prostaglandin (PG) analogue use is associated with alterations in keratocyte density and central corneal thickness (CCT) in subjects with primary open-angle glaucoma (POAG).

          Materials and Methods:

          Thirty-five POAG patients treated with PG analogues for >2 years and 35 control subjects without glaucoma were included in this cross-sectional study. All subjects were underwent CCT measurements using ultrasound pachymetry. Keratocyte densities of each stromal layer were determined by in vivo confocal microscopy. Student's t-test and Chi-square test were used for statistical evaluations. Correlations between keratocyte densities and CCT were analyzed using Pearson's correlation analysis.

          Results:

          Keratocyte densities in each stromal layer were significantly lower in glaucoma patients receiving PG analogues as compared to those of controls ( P < 0.001). The mean CCT was also lower in glaucoma patients (515.2 ± 18.8 μ) than control subjects (549.6 ± 21.1 μ, P < 0.001). A positive correlation between keratocyte densities in each stromal layer and CCT was observed in POAG patients.

          Conclusions:

          Long-term administration of topical PG analogues may adversely influence keratocyte densities and CCT. Further prospective studies are required clarify the relationship between PG analogues and their effects on the cornea.

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          Most cited references25

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          A comparison of latanoprost, bimatoprost, and travoprost in patients with elevated intraocular pressure: a 12-week, randomized, masked-evaluator multicenter study.

          To Internet Advance publication at ajo.com Feb 13, 2003. compare the intraocular pressure (IOP)-lowering effect and safety of latanoprost, bimatoprost, and travoprost in patients with open-angle glaucoma (OAG) or ocular hypertension (OH). Interventional study. This 12-week, randomized, parallel-group study was conducted at 45 US sites. Previously treated patients with OAG or OH and an IOP > or =23 mm Hg in one or both eyes after washout received either latanoprost 0.005%, bimatoprost 0.03%, or travoprost 0.004% once daily in the evening. At baseline and after 6 and 12 weeks of therapy, masked evaluators measured IOP in triplicate at 8:00 AM, 12 noon, 4:00 PM, and 8:00 PM, and masked investigators graded conjunctival hyperemia before the 8:00 AM IOP measurement. The primary efficacy outcome measure was change between baseline and Week 12 in the 8:00 AM IOP (time of peak drug effect). In all, 410 of 411 randomized patients were included in intent-to-treat analyses (latanoprost, 136; bimatoprost, 136; travoprost, 138). Baseline mean 8:00 AM IOP levels were similar (P =.772); by week 12, reductions were observed in all 3 groups (P <.001 for each). Adjusted (ANCOVA) reductions in mean IOP at 8:00 AM were similar (P =.128) as were those at 12 noon, 4:00 PM, and 8:00 PM. Fewer latanoprost-treated patients reported ocular adverse events (P <.001, latanoprost vs bimatoprost), fewer reported hyperemia (P =.001, latanoprost vs bimatoprost), and average hyperemia scores were lower at week 12 (P =.001, latanoprost vs bimatoprost). Latanoprost, bimatoprost, and travoprost were comparable in their ability to reduce IOP in OAG and OH patients. Latanoprost exhibited greater ocular tolerability.
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            Corneal and conjunctival changes caused by commonly used glaucoma medications.

            To evaluate the extent of epithelial corneal and conjunctival changes associated with prolonged use of topical glaucoma medications. Thirty eyes of 15 New Zealand white rabbits were randomized to 1 of 6 treatment groups: artificial tears (Refresh Tears, carboxymethyl cellulose 0.5%) BID, brimonidine Purite 0.15% BID, bimatoprost 0.03% QD, dorzolamide 2% BID, timolol maleate 0.5% BID, or latanoprost 0.005% QD for 30 days. Corneal damage was evaluated by scanning electron microscopy and graded on a standard scale by a masked observer. Conjunctival inflammation was evaluated with light microscopy, and inflammatory cells were counted in the epithelium and superficial and deep stroma by a masked observer according to a standard protocol. In the cornea, artificial tears produced significantly less damage than dorzolamide or latanoprost (P = 0.001), and brimonidine Purite produced significantly less damage than dorzolamide, timolol, or latanoprost (P = 0.001). The mean damage scores with bimatoprost were significantly lower than with dorzolamide, timolol, or latanoprost (P = 0.002). In the conjunctiva, the number of inflammatory cells in the epithelium was significantly lower in eyes treated with artificial tears or brimonidine Purite than in eyes treated with timolol or latanoprost (P = 0.042). Although the adverse effects of glaucoma medications on the ocular surface are likely multifactorial, 1-month treatment with glaucoma medications containing higher levels of benzalkonium chloride (BAK) resulted in greater corneal damage and conjunctival cell infiltration than medications preserved with Purite or with lower levels of BAK. Using glaucoma medications with alternative preservatives or low levels of BAK may help preserve ocular health.
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              An in vivo confocal microscopy analysis of effects of topical antiglaucoma therapy with preservative on corneal innervation and morphology.

              To evaluate the long-term effects of preservative-free and preservative-containing antiglaucoma eye drops on the tear secretion and ocular surface. Comparative retrospective study. A total of 84 patients with bilateral primary open-angle glaucoma or ocular hypertension divided into 5 groups according to type of topical hypotensive therapy and 20 healthy age-matched volunteers were studied. Clinical tests (corneal sensitivity, Schirmer I test, and lachrymal film break-up time), and in vivo confocal microscopy were performed in all patients. A significant reduction of the scores was found between groups on topical hypotensive therapy and the control group in all clinical parameters studied (P .05), with respect to control subjects (P < .001). On the contrary, the density of basal epithelial cells of glaucomatous preservative therapy groups was higher than control and preservative-free groups (P < .05). Stromal keratocyte activation and the number of beads were higher in all glaucoma preservative groups (P < .05). The number of sub-basal nerves was lower in all glaucoma groups than in the control group (P < .05) and tortuosity was significantly higher in glaucoma than control groups (P < .05). Reflectivity of fibers did not show any significant difference between the 6 groups (P < .05). Glaucomatous patients with chronic treatment show ocular surface alterations. The development of nontoxic antiglaucoma treatment may reduce damage to the ocular surface and improve the compliance and the adherence in the medical therapy.
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                Author and article information

                Journal
                Indian J Ophthalmol
                Indian J Ophthalmol
                IJO
                Indian Journal of Ophthalmology
                Medknow Publications & Media Pvt Ltd (India )
                0301-4738
                1998-3689
                January 2015
                : 63
                : 1
                : 15-19
                Affiliations
                [1]Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
                Author notes
                Correspondence to: Dr. Murat Irkec, Hacettepe University, School of Medicine, Department of Ophthalmology, Ankara, Turkey. E-mail: mirkec@ 123456isnet.net.tr
                Article
                IJO-63-15
                10.4103/0301-4738.151456
                4363950
                25686056
                d7fc5498-7dfd-4043-8ffb-e05c6c4c85a1
                Copyright: © Indian Journal of Ophthalmology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 January 2014
                : 25 October 2014
                Categories
                Original Article

                Ophthalmology & Optometry
                in vivo confocal microscopy,keratocyte density,prostaglandin analogues

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