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. 2017 Jun 18;10(6):931-938.
doi: 10.18240/ijo.2017.06.16. eCollection 2017.

Ocular surface evaluation in eyes with chronic glaucoma on long term topical antiglaucoma therapy

Manu Saini  1 , Murugesan Vanathi  1 , Tanuj Dada  1 , Tushar Agarwal  1 , Rebika Dhiman  1 , Sudarshan Khokhar  1
Affiliations

Ocular surface evaluation in eyes with chronic glaucoma on long term topical antiglaucoma therapy

Manu Saini et al. Int J Ophthalmol. .

Abstract

Aim: To evaluate ocular surface changes and its correlation with the central corneal subbasal nerve fibre layer in chronic glaucoma patients.

Methods: A prospective comparative study of ocular surface evaluation was performed in 50 eyes of 25 patients using two or more antiglaucoma medications for at least 6mo and 50 eyes of 25 normal subjects without any ocular problems as controls. The study parameters evaluated included visual acuity, intraocular pressure, ocular surface evaluation parameters [fluorescein break-up time (FTBUT), Schirmer's I test, ocular surface staining scores and ocular surface disease index score (OSDI)], central corneal sensation (Cochet Bonnett aesthesiometer), central subbasal nerve fiber layer density (SBNFLD) by confocal microscopy.

Results: The mean values in the glaucoma cases and control groups respectively were as follows: OSDI score (35.89±16.07/6.02±3.84; P=0.001), Schirmer's I test score (7.63±2.64 mm/12.86±1.93 mm; P=0.001), FTBUT (9.44±2.76s/11.8±1.88s; P=0.001), corneal (5.7±2.33/ 1.1±0.58; P=0.001) and conjunctival staining score (5.06±1.94/0.84±0.46; P=0.001), corneal sensitivity (4.68±0.44/5.07±0.37; P=0.076), mean subbasal nerve fiber number (3.58±0.99/5.40±1.70; P=0.001), SBNFL length (1101.44±287.56 µm/1963.70±562.56 µm; P=0.001) and density (6883.94±1798.03 µm/mm2/12 273.15±3516.04 µm/mm2; P=0.001). Dry eye severity of level 2 and 3 was seen in 66% of glaucoma group. Corneal (R2=0.86) and conjunctival staining (R2=0.71) and OSDI score (R2=0.67) showed statistically significant negative correlation with central corneal SBNFLD while FTBUT (R2=0.84), corneal sensitivity (R2=0.52) showed positive correlation to central corneal SBNFLD in the long term topical antiglaucoma medication group.

Conclusion: Ocular surface changes and antiglaucoma therapy induced dry eye is found to be associated with decreased SBNFLD in eyes on long term topical antiglaucoma medications.

Keywords: confocal microscopy; glaucoma; ocular surface disease; subbasal nerve fiber layer; therapy.

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Figures

Figure 1
Figure 1. In vivo slit scanning confocal microscopy imaging of central cornea of eye on long term antiglaucoma therapy
A: Subbasal nerve fiber layer; B: Tracing of the same using Neuron J (pink). Total nerve number, length/frame of subbasal nerves were measured automatically by Neuron J.
Figure 2
Figure 2. In vivo slit scanning confocal microscopy imaging of central cornea of control eye
A: Subbasal nerve fiber layer; B: Tracing of the same using Neuron J (Pink). Neuron J, a semi-automatic Image J plugin facilitates the quantification of these elongated nerve structures.
Figure 3
Figure 3. Correlation of OSDI scores with central corneal subbasal nerve (nr) fiber density in eyes on longterm antiglaucoma therapy.
Figure 4
Figure 4. Correlation of corneal staining score with central corneal subbasal nerve (nr) fiber density in eyes on longterm antiglaucoma therapy.
Figure 5
Figure 5. Correlation of conjunctival staining score with central corneal subbasal nerve (nr) fiber density in eyes on longterm antiglaucoma therapy.
Figure 6
Figure 6. Correlation of TBUT with central corneal subbasal nerve (nr) fiber layer density in eyes on longterm antiglaucoma medication therapy.
Figure 7
Figure 7. Correlation of central corneal sensation threshold with subbasal nerve (nr) fiber density in eyes on longterm antiglaucoma therapy.
Figure 8
Figure 8. Correlation of Schirmer's I test with central corneal sub-basal nerve (nr) fiber density in eyes on longterm antiglaucoma therapy.
Figure 9
Figure 9. Bland-Altman plots for subbasal fiber layer density, length and number in eyes on antiglaucoma treatmemt indicating agreement between two separate measurements at different instances of the same eye, by same observer
rpt: Repeat.
Figure 10
Figure 10. Bland-Altman plots for subbasal nerve fiber layer density, length, nerve number in eyes in the control group, indicating agreement between two seperate measurements at different instances of the same eye, by same observer
rpt: Repeat.
See this image and copyright information in PMC

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