Traitement du glaucome, conservateurs et surface oculaire

[Ocular surface disease in glaucoma patients: Expert opinion and management algorithm in Algeria]

INTRODUCTION

The main goal of treatment for any glaucoma patient is to reduce the intraocular pressure. Unfortunately, the long-term use of glaucoma medications causes deleterious effects on the ocular surface, leading to impaired quality of life and failed glaucoma surgery. In addition, adverse effects of medications are a barrier to adherence and compliance, and this directly affects efficacy. It is therefore essential to regularly assess the ocular surface of glaucoma patients in order to detect any signs of damage early and act accordingly. Although the TFOS DEWS 2 now offers a strategy for diagnosing ocular surface pathologies, some examinations are unfortunately not feasible in Algeria due to lack of time and/or knowledge on the part of some ophthalmologists or are simply inaccessible to others.

METHODS

Algerian experts (members of the ACOS club) met for the purpose of proposing an algorithm for the management of Algerian glaucoma patients, based on the recommendations of the DEWS, their own practice and the results of a preliminary national survey of ophthalmologists.

RESULTS

The proposed algorithm allows evaluation of the ocular surface of the glaucoma patient in current practice by any Algerian ophthalmologist.

CONCLUSION

Management of glaucoma patients should include a systematic examination of the ocular surface. The choice of treatment should be determined by the ocular surface condition of the glaucoma patient.

Predictors for elevation of Intraocular Pressure (IOP) on glaucoma patients; a retrospective cohort study design

OBJECTIVE

Because of the increase in the number of cases, currently, glaucoma is a significant public health issue that it leads to optic nerve damage and vision loss. High Intraocular Pressure reading indicates that the treatment given to a glaucoma patient is not sufficient/ adequate. Hence, the elevation of intraocular pressure is one of the indicators that, the therapy given to glaucoma patients under treatment is inadequate. Therefore, the main objective of the current study was to investigate predictors for the variation of elevation of IOP readings on glaucoma patients.

MATERIALS AND METHODS

A retrospective cohort study design was conducted on 1254 glaucoma patients, whose followed-ups were from September 2015 to August 2016 at Felege Hiwot Teaching and Specialized Hospital, North West Ethiopia. Data analysis was conducted using Statistical Analysis of Systems (SAS) software version 9.2 and AMOS software. The parameter estimation was conducted using the maximum likelihood estimation technique.

RESULTS

Main effects like age (β = 0.01, t-value = 0.15, p-value = 0.018), patients with normal blood pressure (β = -3.35, t-value = -2.28, p-value = 0.0263), patients without diabetics (β = -3.79, t-value = -2.47, p-value = 0.014), visiting times (β = -6.00, t-value = -5.02, p-value = 0.0001), farmer glaucoma patients (β = -6.04, t-value = 3.87, p-value = 0.0001) had significant and indirect effect for the variation of elevation of IOP on glaucoma patients. Interaction effects like visiting time with existence of diabetes, visiting time with cataract surgery significantly effected on the variable of interest. Hence, both main and interaction effects had significant effects on the variable of interest. This study had identified socio-demographic characteristics, personal/individual behaviors, and clinical factors for the variation of elevation of IOP. The findings, in the current investigation, help health staff to conduct health-related education for awareness creation. Health-related education, about the progression of glaucoma, should be conducted on patients.

Lipidomic analysis of human corneal epithelial cells exposed to ocular irritants highlights the role of phospholipid and sphingolipid metabolisms in detergent toxicity mechanisms

Detergent chemicals, widely used in household products, in pharmaceutical, medical, cosmetic and industrial fields, have been linked to side effects and involved in several eye diseases. On the ocular surface, detergents can interfere with the corneal epithelium, the most superficial layer of the cornea, representing a line of defence against external aggression. Despite its major role in numerous biological functions, there is still little data regarding disruption of lipid homeostasis induced by ocular irritants. To this purpose, a lipidomic analysis using UPLC-HRMS/MS-ESI ± was performed on human corneal epithelial (HCE) cells incubated with three widely known ocular irritants: benzalkonium chloride (BAK), sodium lauryl sulfate (SLS) and Triton X-100 (TXT). We found that these ocular irritants lead to a profound modification of the HCE cell lipidome. Indeed, the cell content of ceramide species increased widely while plasmalogens containing polyunsaturated fatty acid species, especially docosahexaenoic acids, decreased. Furthermore, these irritants upregulated the activity of phospholipase A₂. The present study demonstrates that BAK, SLS and TXT induced disruption of the cell lipid homeostasis, highlighting that lipids mediate inflammatory and cell death processes induced by detergents in the cornea. Lipidomics may thus be regarded as a valuable tool to investigate new markers of corneal damage.

European real-world data about the use of a new delivery system containing a preservative-free multi-dose glaucoma treatment

Background

Glaucoma treatments are mostly presented in uni-dose or multi-dose format. A certain number of patients with visual acuity and dexterity problems may have problems in instilling eye drops.

Aim

To assess patient satisfaction and ease of use of a preservative-free glaucoma treatment (dorzolamide/timolol) in a new and innovative patented multi-dose delivery system.

Methods

Retrospective, international, multicentre, non-interventional study in 788 adult patients using a multi-dose delivery system for at least 28 days.

Results

Mean patient age was 68.1 ± 12.1 years. Mean duration of multi-dose delivery system use was 132.1 ± 125.1 days; 66.5% of the patients previously used multi-dose and 33.5% uni-dose delivery systems (n = 734); 78.3% of the patients were satisfied or very satisfied with the multi-dose delivery system. A significant majority (all p ≤ 0.045) of patients with a QuickDash® score between [0 to 25[ (66.4%, n = 211) and [50 to 75[ (81.8%, n = 11) rated multi-dose delivery system as easy or very easy to open and significantly more subjects in the [0 to 25[ (72%) score group rated multi-dose delivery system as being better or much better than their previous device (n = 211). Significantly (all p < 0.01) more subjects with available visual acuity results rated multi-dose delivery system as good, better or much better than their previous dispensing device.

Conclusion

The tested multi-dose delivery system was highly accepted. It is, therefore, suitable for glaucoma patients with decreased visual acuity and/or dexterity problems. Further studies may be necessary to assess the easiness of use of this easy-to-grip delivery system.

Altered expression level of inflammation-related genes and long-term changes in ocular surface after trabeculectomy, a prospective cohort study

PURPOSE

We aim to evaluate changes in the ocular surface in a cohort of post-trabeculectomy patients and whether these were associated with conjunctival inflammatory gene expression.

METHODS

This is a single-arm interventional cohort performed in a tertiary referral center. These were assessed: dry eye symptom questionnaire, tear osmolarity, Schirmer's test, non-invasive tear break up time (BUT), conjunctival redness and corneal fluorescein staining evaluation. Conjunctival impressions were performed using Eyeprim, and after RNA extraction, transcripts of 255 inflammatory genes were analysed using the Nanostring nCounter assay.

RESULTS

Thirty three patients were recruited with age 66.88 ± 9.76 at baseline, with a predominance of men. There was a significant decrease in inferior corneal staining at 6 months (p < 0.05) (n = 22) and significant decrease in tear osmolarity at 12 months (p < 0.01) (n = 27). No patient required glaucoma eyedrops post-surgery up to 3 years. At baseline 31/33 transcript profiles passed the quality control, and after normalization, 249 transcripts were subsequently analysed. Increased discomfort was associated with higher Protein Tyrosine Kinase-2 at the cross-sectional analysis at baseline. Lower baseline complement factor-D and higher levels of Mitogen associated kinase-8, MAP3K1 and MyD88, were associated with presence of corneal staining at 6 months. Nine genes, including the proinflammatory lipo-oxygenase (ALOX5) showed a significantly reduced level at 3 years (n = 5).

CONCLUSIONS

Glaucoma surgery may confer long term beneficial effect on the ocular surface, if anti-glaucoma eyedrops are no longer necessary. This may be due to reduced expression of conjunctival proinflammatory genes and immune-related genes.