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Ocular lubricant use in medically and surgically treated glaucoma: a retrospective longitudinal analysis

Authors Iyer JV, Zhao Y, Lim FPM, Tong L, Wong TTL

Received 13 February 2017

Accepted for publication 13 April 2017

Published 23 June 2017 Volume 2017:11 Pages 1191—1196

DOI https://doi.org/10.2147/OPTH.S134570

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Jayant Venkatramani Iyer,1–3 Yang Zhao,3 Fiona Pin Miao Lim,1,2 Louis Tong,1–4 Tina Tzee Ling Wong1–4

1Glaucoma, Singapore National Eye Centre, 2Singapore Eye Research Institute, 3Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 4Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore

Background: Chronic use of intraocular pressure-lowering medications is associated with ocular surface disease (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.
Methods: 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 follow-up.
Results: 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), 42.8% were women. One hundred one (20.0%) patients underwent phacoemulsification surgery, 80 underwent mitomycin C (MMC) augmented phacotrabeculectomy, 16 underwent MMC-augmented trabeculectomy and 3 underwent tube surgery during the course of follow-up as their only type of surgery. Five-year incidence of lubricant use was 59% in all glaucoma subjects; 54.1% of patients were on medical treatment and 74.0% of patients who underwent phacotrabeculectomy or trabeculectomy were started on lubricants, respectively (P=0.0011); 60.4% of glaucoma subjects who underwent phacoemulsification surgery were started on lubricants. Incidence of lubricant use increased from 17.7% preoperatively to 74.0% 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 more likely to use artificial tears compared with males (P=0.002).
Conclusion: 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.

Keywords: glaucoma, medications, trabeculectomy, ocular surface disease, ocular lubricants

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