Evaluation of Ocular Surface Disease in Glaucoma Patients Using Topical Antiglaucomatous Agents

Yıl 2017, Cilt: 1 Sayı: 3, 116 - 121, 15.12.2017

Tevfik Oğurel , Reyhan Oğurel Murat Atabey Özer Zafer Onaran

https://doi.org/10.30565/medalanya.342369

Cited By: 1

Öz

Aim: Evaluation of ocular surface disease (OSD) in glaucoma patients using
topical antiglaucomatous agents

Patients
and Method: 159 eyes of 83 patients at the age 18 years or over,
who had any types of different glaucoma and had been using antiglaucomatous
agents for at least 6 months were included in the study. The Ocular Surface
Disease Index (OSDI) questionnaire was filled by asking patients individually.
Afterwards, in order to examine ocular surface clinically, patients underwent
the Schirmer test(under anesthesia) evaluation, tear break-up time(TBUT) and
corneal staining.

Results: A total of 159 eyes from 51 male and 32 female patients were included
in the study. The average age of men was 64,51 ± 9,07 and the average age of
women was 54,32 ± 11,44. Mean duration of medication use of the patients was
6.35 ± 5.63 years. 36.5% of the patients had single medication, 32.1% had two
medications, 13.8% had three medications and 17.6% had four medications. Of the
patients whose dry eye symptoms were assessed using the OSDI questionnaire,
3.8% were normal, 15.7% were mild, 22.6% were moderate and 57.9% were severe
dry eye. The mean OSDI score of all patients was 46.80 ± 19.44. The Schirmer
test was found at less than 5 mm in 34.1% of eyes. In terms of TBUT, 52.3% of
the eyes were evaluated as mild, 29.5% as moderate, 8.5% as severe. When
evaluated for corneal staining, normal staining was observed in 13.2%, slight
staining in 39.6%, moderate staining in 23.3% and severe staining in 23.9%.

Conclusion: In diagnosing OCD, it would also be beneficial to use a test that
includes not only the OSDI questionnaire but also tests showing the quality and
stability of the tears.

Anahtar Kelimeler

Glaucoma, Antiglaucomatous agents, Ocular Surface Disease

Antiglokomatöz İlaç Kullanan Glokom Hastalarında Oküler Yüzey Hastalığının Değerlendirilmesi

Öz

Amaç: Topikal antiglokomatöz
ilaç kullanan glokom hastalarında oküler yüzey hastalığını (OYH) değerlendirmek

Hastalar
ve Yöntem: Çalışmaya herhangi bir değişik tipte
glokomu olan ve en az 6 aydır glokom ilacı kullanan 18 yaş üstü 83 hastanın 159
gözü çalışmaya dâhil edildi. Oküler yüzey hastalık endeks(OSDI) anketi
hastalara tek tek sorularak dolduruldu. Sonrasında hastalarda oküler yüzeyi
klinik olarak değerlendirmek için schirmer testi (anestezili), gözyaşı kırılma
zamanı(GKZ) ve korneal boyanmaya bakıldı.

Bulgular: Çalışmaya
51 erkek 32 kadın hastanın 159 gözü dâhil edildi.  Erkeklerin yaş ortalaması 64,51±9,07
bayanların yaş ortalaması 54,32±11,44 idi. Hastaların ortalama ilaç kullanım
süreleri 6,35±5,63 yıldı. Hastaların %36,5’i tek ilaç ,%32,1’i iki ilaç,
%13,8’i üç ilaç ve %17,6’sı dört ilaç kullanmaktaydı. OSDI anketi kullanılarak
kuru göz semptomları değerlendirilen hastaların %3,8’i normal, % 15,7’si hafif,
%22,6’sı orta ve %57,9 şiddetli kuru göz hastası olarak değerlendirildi. Tüm
hastaların ortalama OSDI skoru 46,80±19,44’tü. Schirmer testi gözlerin
%34,1’inde 5 mm’nin altında saptandı. GKZ gözlerin % 52,3’de hafif,%29,5’de
orta, %8,5,de şiddetli olarak değerlendirildi. Korneal boyanma açısından
değerlendirildiğinde ise gözlerin %13,2’da normal boyanma, %39,6’de hafif
boyanma, %23,3’de orta derecede boyanma ve %23,9’da ise şiddetli boyanma
mevcuttu.

Sonuç: OYH'nın
teşhis edilmesinde, sadece OSDI anketinin kullanılmasının yanı sıra, gözyaşı
kalitesini ve stabilitesini gösteren testleri de içeren bir testin kullanılması
da sağlıklı olacaktır.

Anahtar Kelimeler

Glokom, Antiglokomatöz İlaçlar, Oküler Yüzey Hastalığı

Kaynakça

• 1. Lemp MA. Report of the National Eye Institute/Industry Workshop on clinical trials in dry eyes. CLAO J.1995;21(4):221–32 2. Miljanovic B, Dana R, Sullivan DA, Schaumber DA. Impact of dry eye syndrome on vision-related quality of life. Am J Ophthalmol 2007;143(3):409-15
• 3. Schein OD, Muñoz B., Tielsch JM, Bandeen-Roche K, West S. Prevalence of dry eye among the elderly. Am. J. Ophthalmol. 1997;124(6):723–728
• 4. Erdem U, Ozdegirmenci O, Sobaci E et al. Dry eye in post-menopausal women using hormone replacement therapy. Maturitas 2007;56(3):257–62
• 5. Foulks GN, Lemp MA, Jester JV, Sutphin J, Murube J, Novack GD. Challenges and pitfalls in clinical trials of treatments for dry eye. Ocul. Surf. 2003;1(1):20–30
• 6. Kastelan S, Tomic M, Metez Soldo K, Salopek-Rabatic J. How ocular surface disease impacts the glaucoma treatment outcome. Biomed. Res. Int. 2013;(2013):7
• 7. Stewart WC, Stewart JA, Nelson LA. Ocular surface disease in patients with ocular hypertension and glaucoma. Current Eye Research. 2011;36(5):391-398
• 8. Pisella PJ, Pouliquen P, Baudouin C. Prevalence of ocular symptoms and signs with preserved and preservative free glaucoma medication. Br J Ophthalmol. 2002;86(4):418–423
• 9. Wilson WS, Duncan AJ, Jay JL. Effect of benzalkonium chloride on the stability of the precorneal tear film in rabbit and man. Br J Ophthalmol. 1975;59(11):667–669
• 10. Baudouin C. Mechanisms of failure in glaucoma filtering surgery: a consequence of antiglaucomatous drugs? Int J Clin Pharmacol Res. 1996;16(1):29-41
• 11. Bron AJ, Abelson MB, Ousler G et al. Methodologies to diagnose and monitor dry eye disease: report of the Diagnostic Methodology Subcommittee of the International Dry Eye WorkShop (2007). Ocul. Surf. 2007;5(2):108–152
• 12. Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL. Reliability and validity of the ocular surface disease index. Arch Ophthalmol. 2000;118(5):615-621
• 13. Skalicky SE, Goldberg I, McCluskey P. Ocular surface disease and quality of life in patients with glaucoma. Am J Ophthalmol. 2012;153(1):1–9
• 14. Rosin LM, Bell NP. Preservative toxicity in glaucoma medication: clinical evaluation of benzalkonium chloride-free 0.5% timolol eye drops. Clin Ophthalmol. 2013;2013(7):2131–2135
• 15. Rossi GC, Tinelli C, Pasinetti GM, Milano G, Bianchi PE. Dry eye syndrome-related quality of life in glaucoma patients. Eur J Ophthalmol. 2009;19(4):572-579
• 16. Fechtner RD, Godfrey DG, Budenz D, Stewart JA, Stewart WC, Jasek MC. Prevalence of ocular surface complaints in patients with glaucoma using topical intraocular pressure-lowering medications. Cornea. 2010;29(6):618-21
• 17. Leung EW, Medeiros FA, Weinreb RN. Prevalence of ocular surface disease in glaucoma patients. J Glaucoma. 2008;17(5):350-355
• 18. Schein OD, Tielsch JM, Munoz B, Bandeen-Roche K, West S . Relation between signs and symptoms of dry eye in the elderly. A population-based perspective. Ophthalmology. 1997;104(9):1395–1401
• 19. Hay EM, Thomas E, Pal B, Hajeer A, Chambers H, Silman A J. Weak association between subjective symptoms or and objective testing for dry eyes and dry mouth: results from a population based study. Ann Rheum Dis. 1998;57(1):20–24
• 20. Bayer A, Ozge G. Glokom, Glokom İlaçları ve Kuru Göz. MN Oftalmoloji. 2016;23(1):91-95