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Br J OphthalmolAugust 20199 citations

Tear neuromediators in eyes on chronic topical antiglaucoma therapy with and without BAK preservatives.

Murugesan Vanathi, Dwivedi Roopa, Saini Manu, Gupta Viney, Dada Tanuj, Vivekanandhan S


AI Summary

Chronic glaucoma drops alter tear neuropeptides, but BAK-preserved and BAK-free drops showed no significant difference in these levels or corneal nerve density, suggesting similar neuro-inflammatory impact.

Abstract

Purpose

To evaluate tear neuropeptides (NPs) (vasoactive intestinal peptide (VIP), neuropeptide Y (NPY), calcitonin gene-related peptide (CGRP), substance P (SP), nerve growth factor (NGF)) in chronic ocular topical hypotensive therapy with and without benzalkonium chloride (BAK) preservative.

Methods

A comparative, open label, cross-sectional study of patients using antiglaucoma medications for > 6 months with BAK (group I), without BAK (group II) and controls was done. Tear NPs (ELISA), ocular surface evaluation tests (tear breakup time (TBUT), Schirmer's test, corneal and conjunctival staining score) and confocal central corneal subbasal nerve fibre layer (SBNFL) imaging was done.

Results

Of 153 eyes evaluated, group 1 (82 eyes (41 patients; mean age 48±14.5 years)) and group 2 (71 eyes (36 patients; mean age 43.11±15 years)) were on therapy for a mean duration of 10.05±2.0 and 9.67±2.3 months, respectively. Tear analysis showed elevated SP and NGF (p<0.01); decreased CGRP (p=0.03), VIP and NPY (p<0.01) compared with controls (n=30, mean age 29.33±5.7 years). Tear NP levels (SP (p=0.1), NGF (p=0.33), CGRP (p=1), VIP (p=0.87), NPY (p=0.83)) and SBNFL (p=0.09) were comparable in both groups. There was no correlation seen between tear NP levels and clinical tests and SBNFL.

Conclusion

Our study analysis points towards altered tear NP levels in eyes on chronic topical hypotensive therapy in comparison with controls with no significant difference in tear NP levels and central corneal SBNFL density between the BAK preservative and BAK-free antiglaucoma therapy.


MeSH Terms

Administration, OphthalmicAdolescentAdultAgedAntihypertensive AgentsBenzalkonium CompoundsCalcitonin Gene-Related PeptideCross-Sectional StudiesEnzyme-Linked Immunosorbent AssayEye ProteinsFemaleGlaucoma, Open-AngleHumansMaleMiddle AgedNerve Growth FactorNeuropeptide YNeuropeptidesOphthalmic SolutionsPreservatives, PharmaceuticalProspective StudiesSubstance PTearsVasoactive Intestinal PeptideYoung Adult

Key Concepts5

In eyes on chronic topical antiglaucoma therapy, tear analysis showed elevated substance P (SP) and nerve growth factor (NGF) (p<0.01) compared with controls (n=30, mean age 29.33±5.7 years).

MechanismCross-sectionalComparative Cross-sectional Studyn=153 eyes evaluated (82 eyes on BAK th…Ch29Ch35

In eyes on chronic topical antiglaucoma therapy, tear analysis showed decreased calcitonin gene-related peptide (CGRP) (p=0.03), vasoactive intestinal peptide (VIP) and neuropeptide Y (NPY) (p<0.01) compared with controls (n=30, mean age 29.33±5.7 years).

MechanismCross-sectionalComparative Cross-sectional Studyn=153 eyes evaluated (82 eyes on BAK th…Ch29Ch35

Tear neuropeptide levels (substance P (p=0.1), nerve growth factor (p=0.33), calcitonin gene-related peptide (p=1), vasoactive intestinal peptide (p=0.87), neuropeptide Y (p=0.83)) and central corneal subbasal nerve fibre layer (SBNFL) (p=0.09) were comparable between eyes on antiglaucoma therapy with benzalkonium chloride (BAK) preservative (group 1, 82 eyes) and without BAK (group 2, 71 eyes).

Comparative EffectivenessCross-sectionalComparative Cross-sectional Studyn=153 eyes evaluated (82 eyes on BAK th…Ch29Ch35

There was no correlation seen between tear neuropeptide levels and clinical tests (tear breakup time, Schirmer's test, corneal and conjunctival staining score) and central corneal subbasal nerve fibre layer (SBNFL) in patients on chronic topical antiglaucoma therapy.

DiagnosisCross-sectionalComparative Cross-sectional Studyn=153 eyes evaluatedCh29Ch35

A comparative, open label, cross-sectional study evaluated 153 eyes from patients using antiglaucoma medications for > 6 months with benzalkonium chloride (BAK) (group I, 82 eyes (41 patients; mean age 48±14.5 years)) or without BAK (group II, 71 eyes (36 patients; mean age 43.11±15 years)), and controls (n=30, mean age 29.33±5.7 years).

MethodologyCross-sectionalComparative Cross-sectional Studyn=153 eyes from 77 patients and 30 cont…Ch28Ch29

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