Clinical Ophthalmology (Sep 2022)
Tolerability in Glaucoma Patients Switched from Preserved to Preservative-Free Prostaglandin-Timolol Combination: A Prospective Real-Life Study
Abstract
Sonja Jandroković,1,2 Sania Vidas Pauk,1 Dina Lešin Gaćina,1 Ivan Skegro,1,2 Martina Tomić,3 Sanja Masnec,1,2 Tomislav Kuzman,1,2 Miro Kalauz1,2 1Department of Ophthalmology, University Clinical Hospital Center Zagreb, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, CroatiaCorrespondence: Sania Vidas Pauk, Department of Ophthalmology, Zagreb University Hospital Center, Kišpatićeva 12, Zagreb, 10000, Croatia, Tel +385989371397, Fax +38512388430, Email [email protected]: To evaluate the effect of switching from preserved prostaglandin analog-timolol fixed combinations (PG-timolol FCs) to preservative-free latanoprost-timolol FC (PF-LT) on intraocular pressure (IOP), ocular surface health, and tolerability in glaucoma and ocular hypertension (OH) patients with the concurrent ocular surface disease (OSD).Methods: This was a longitudinal, prospective, interventional, real-life study among 42 patients. Up to 3 visits were planned, at baseline, 30, and 90 days to assess efficacy on IOP decrease and local tolerance. The severity of OSD symptoms [Ocular Surface Disease Index (OSDI) questionnaire], subjective drug tolerability [visual analog scale (VAS)], conjunctival hyperemia (McMonnies scale), and tear break-up time (TBUT) were the main parameters assessed.Results: Data from 36 patients were available for statistical analysis. IOP was significantly reduced at day 30 and day 90 compared to baseline (16 vs 14 vs 14 mmHg, p < 0.001). Significant improvement was demonstrated in OSD symptoms, signs, and VAS scores from the baseline to the second and third visits. Median OSDI (27.1 vs 9.6 vs 4.2, p < 0.001), conjunctival hyperemia (2 vs 1 vs 1, p < 0.001), corneal surface staining (p < 0.001), and conjunctival staining scores (p < 0.001), and the percentage of patients with eyelid and periocular hyperemia (61.1 vs 12.5 vs 2.8%, p < 0.001), significantly decreased. TBUT (4 vs 5 vs 6 s, p < 0.001) and VAS score regarding tolerability (5 vs 2 vs 1, p < 0.001) significantly increased.Conclusion: A switch from preserved PG-timolol FCs to PF-LT improved tolerability and optimized IOP control, providing better adherence with greater chances of treatment success.Keywords: glaucoma, prostaglandin analogs, preservative, benzalkonium chloride, preservative-free, fixed combinations