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Jayant Venkatramani Iyer, Yang Zhao, Fiona Lim, Louis Tong, Tina T Wong; Ocular lubricant use in medically and surgically treated glaucoma. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2665.
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Chronic use of intraocular pressure (IOP) lowering medications is associated with ocular surface disease (OSD). Ocular lubricants are regularly used in management of OSD. In this study we assess the incidence of topical lubricant use as a surrogate marker for underlying OSD, in medically and surgically treated glaucoma patients over 5 years of review.
Retrospective chart review was performed for newly diagnosed glaucoma patients who were started on topical medications in 2007 and followed up over a 5-year period. Primary outcome measure was the incidence of topical lubricant use in these patients and a subset of these patients who required glaucoma or cataract surgery during followup.
Charts of 505 newly diagnosed glaucoma patients with no prior history of ocular lubricant use were analyzed. Mean age was 63.9 years (SD: 11.1) and 42.8% were women. 124 (24.6%) of these patients underwent phacoemulsification surgery, 97 underwent mitomycin C (MMC) augmented phacotrabeculectomy, 25 underwent MMC-augmented trabeculectomy and 3 underwent tube surgery over the course of followup. 5-year incidence of lubricant use was 59% in all glaucoma subjects. 52.8% of patients on medical treatment and 72.9% of patients who underwent phacotrabeculectomy or trabeculectomy required lubricants respectively (p=0.005). 60.4% of glaucoma subjects who underwent phacoemulsification surgery required lubricant use. Incidence of lubricant use increased from 21.3% preoperatively to 71.3% postoperatively in subjects who required trabeculectomy or phacotrabeculectomy. Incidence of lubricant use was similar in patients on one or multiple glaucoma medications, with the mean onset of lubricant use being 10 months after starting glaucoma medication in both groups. Females were also more likely to require artificial tears compared to males (p=0.002).
Both medical and surgical management of glaucoma have an adverse effect on the ocular surface. Chronic use of glaucoma medications was associated with a high incidence of ocular lubricant use. MMC-augmented trabeculectomy was associated with an even higher incidence of ocular lubricant use with this surgery increasing the need for topical lubricants more than threefold postoperatively.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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