Publication: Evaluación de la superficie ocular en pacientes con tratamiento hipotensor tópico
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2018-11-26
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Universidad Complutense de Madrid
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Abstract
El glaucoma se define como una neuropatía óptica crónica y progresiva. El factor de riesgo más importante para el desarrollo de glaucoma, así como para su progresión, es una presión intraocular (PIO) elevada. Así, los fármacos hipotensores tópicos, que reducen la PIO, son la terapia de primera línea requiriendo la mayoría de los pacientes tratamiento a lo largo de su vida.El término “patología de la superficie ocular (PSO)” describe un amplio espectro de condiciones tales como síndrome de ojo seco (SOS), blefaritis, conjuntivitis y queratitis. La PSO se observa con frecuencia en pacientes con glaucoma y surge, en gran medida, como consecuencia del uso crónico de la terapia hipotensora tópica. La PSO es una de las responsables de la frecuente mala adherencia al tratamiento de los pacientes con glaucoma, así como del empeoramiento de la calidad de vida del paciente.Hoy en día hay cada vez más evidencia de que los conservantes, presentes en la formulación de algunos medicamentos anti-glaucomatosos tópicos, empeoran los signos y síntomas de la PSO. El cloruro de benzalconio (en inglés, BAK) es uno de los primeros conservantes introducidos y el más utilizado actualmente. Varios estudios in vitro y en modelo animal han demostrado que las soluciones preservadas con BAK causan neurotoxicidad corneal, disrupción de la película lagrimal y daño en la malla trabecular. Numerosos estudios clínicos observacionales han evaluado el papel desempeñado por los conservantes en la PSO...
Glaucoma is a chronic, progressive optic neuropathy. The most significant risk factor for developing glaucoma and for its progression is elevated intraocular pressure (IOP). This means that topical IOP-lowering eye drops are the first line therapy for glaucoma, with most patients requiring treatment throughout their lives.The term ocular surface disease (OSD) describes a wide spectrum of conditions such as dry eye syndrome (DES), eye lid disease, conjunctivitis and keratitis. OSD is frequently observed in glaucoma patients and is thought to be the consequence of the chronic use of IOP-lowering eye drops. As a co-morbidity of glaucoma, OSD has been held responsible for poor treatment adherence and worsening of patient quality of life.Today, there is increasing evidence to suggest that the preservatives used in anti-glaucoma medications may worsen the signs and symptoms of OSD. Benzalkonium chloride (BAK) is one of the first preservatives introduced and is currently the most widely used ophthalmic preservative. Several in vitro and animal studies have shown that solutions containing BAK cause corneal neurotoxicity, tear film disruption and trabecular meshwork damage. Numerous observational clinical studies have assessed the role played by preservatives in OSD. The presence of BAK in latanoprost –the most frequently prescribed prostalandin– is associated with conjunctival hyperemia, superficial punctate keratopathy, or squamous metaplasia..
Glaucoma is a chronic, progressive optic neuropathy. The most significant risk factor for developing glaucoma and for its progression is elevated intraocular pressure (IOP). This means that topical IOP-lowering eye drops are the first line therapy for glaucoma, with most patients requiring treatment throughout their lives.The term ocular surface disease (OSD) describes a wide spectrum of conditions such as dry eye syndrome (DES), eye lid disease, conjunctivitis and keratitis. OSD is frequently observed in glaucoma patients and is thought to be the consequence of the chronic use of IOP-lowering eye drops. As a co-morbidity of glaucoma, OSD has been held responsible for poor treatment adherence and worsening of patient quality of life.Today, there is increasing evidence to suggest that the preservatives used in anti-glaucoma medications may worsen the signs and symptoms of OSD. Benzalkonium chloride (BAK) is one of the first preservatives introduced and is currently the most widely used ophthalmic preservative. Several in vitro and animal studies have shown that solutions containing BAK cause corneal neurotoxicity, tear film disruption and trabecular meshwork damage. Numerous observational clinical studies have assessed the role played by preservatives in OSD. The presence of BAK in latanoprost –the most frequently prescribed prostalandin– is associated with conjunctival hyperemia, superficial punctate keratopathy, or squamous metaplasia..
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Tesis de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Oftalmología y Otorrinolaringología, leída el 20-02-2018