Keratographic Assessment of Dry Eye Disease Associated to Topical Glaucoma Treatment. Comparison between Operated and Non-Operated Eyes.

Abstract

Purpose : IOP-lowering drugs instillation is an efficient form of glaucoma therapy. A large proportion of patients require multiple eye drops during the day, therefore increasing the frequency of side-effects. Medical treatment may cause ocular surface chronic inflammation or aggravation of a concomitant dry eye disease (DED). However, trabeculectomy commonly reduces the need of IOP-lowering drops. The aim of this study is to investigate comparative ocular surface clinical parameters of patients with one eye under topical glaucoma treatment, versus the fellow eye operated with trabeculectomy and no topical medical treatment.

Methods : Twenty-one glaucoma patients participated in the study. All patients underwent trabeculectomy (TRAB) in only one eye having no need to use topical treatment. The fellow eyes (NOTRAB) were under anti-glaucoma treatment. TRAB eyes had lower IOP (P=0.0011) when compared to NOTRAB eyes. After proper informed consent, a video-keratographic assessment (Keratograph 5M by Oculus) was performed generating diverse ocular surface information under the Jenvis Dry Eye Report (OSDI questionnaire, tear film osmilarity, non-invasive BUT, redness scale, meibography, tear meniscus height, eye blink frequency, lipid layer analysis). An ophthalmological examination was performed. Quality of life was evaluated with the NEI VFQ-25 tool.

Results : The mean age of patients was 69.9±11.2 years. NOTRAB eyes had been under topical treatment for 6.28±4.37 yrs with a mean number of 2.85±1.15 meds. Mean time since trabeculectomy was 2.9±2.66 years. Patients studied had a mean OSDI value of 31.76±12.87 and a mean NEI-VFQ25 score of 29.66±2.76. TRAB eyes had larger c/d ratios (P=0.041) and worse visual field indexes (P<0.05). Regarding DED assessment (keratographic findings), NOTRAB eyes had significantly greater proportion of both meibomitis (P=0.0002) and conjuntivochalasia (P=0.047) as compared to TRAB eyes. NOTRAB eyes had a larger fluorescein corneal staining (P=0.0001), more affected meibography findings (P=0.016), and higher values of osmolarity (P=0.023). The Jenvis Index was larger in the TRAB eyes (39.47±11.57 vs. 31.52±12.16, P=0.036).

Conclusions : Topical IOP-lowering treatment cause more clinical findings of DED. Trabeculectomy not only helps to control IOP but also significantly improves the impact of DED. Keratography is a good complement in this setting

This is a 2020 ARVO Annual Meeting abstract.