title: Efficacy of indomethacin 0.1% and fluorometholone 0.1% on conjunctival inflammation following chronic application of antiglaucomatous drugs.
abstract: BACKGROUND
  Subclinical conjunctival inflammation has been shown to have a deleterious effect on the outcome of filtering surgery. The study was designed to assess the efficacy and safety of a non-steroidal anti-inflammatory ophthalmic solution (preservative-free indomethacin 0.1%) on conjunctival inflammation following chronic application of antiglaucomatous drugs, in comparison with a steroidal ophthalmic solution (preserved fluorometholone).
  
  
  METHODS
  Eighty-nine glaucomatous patients were included in a randomised, multicentre study comparing two parallel groups of treatment given on the basis of 1 drop 4 times daily for 1 month before filtering surgery. Patients had been treated with one or more antiglaucomatous drugs for at least 3 years. The routine antiglaucomatous treatment was continued during the study. Evaluations were carried out at baseline and after 30 days of treatment. Conjunctival inflammation was assessed under masked conditions by means of conjunctival impression analysis which determined the percentage of cells expressing HLA-DR. The ocular surface was also examined using the fluorescein test and lissamine green staining.
  
  
  RESULTS
  Paired conjunctival impression specimens available both on day 0 (D0) and day 30 (D30) involved 49 patients. Among them, 34 eyes had a positive expression of HLA-DR at inclusion. On D30, in patients positive to HLA-DR on D0, the percentage of cells expressing HLA-DR had significantly decreased in both treatment groups: the mean reduction was 29.7% from a baseline value of 51.4% in the indomethacin group ( P=0.019) and 32.5% from a baseline value of 48.7% in the fluorometholone group ( P<0.001). There was no significant difference between groups. Seven cases of drug-related superficial punctate keratitis were observed on D30 by means of a fluorescein test: one in the indomethacin group and six in the fluorometholone group.
  
  
  CONCLUSIONS
  Both anti-inflammatory eyedrops were effective in reducing subclinical conjunctival inflammation before filtering surgery. Regarding superficial punctate keratitis, the corneal tolerance of preservative-free indomethacin 0.1% eyedrops seemed to be better than that of preserved fluorometholone eyedrops.
authors.affiliation: Hôpital A. Paré, Boulogne-Billancourt, France. baudouin@quinze-vingts.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Baudouin
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Nordmann
authors.forename: Philippe
authors.initials: P
authors.lastname: Denis
authors.forename: Catherine
authors.initials: C
authors.lastname: Creuzot-Garcher
authors.forename: Catherine
authors.initials: C
authors.lastname: Allaire
authors.forename: Claude
authors.initials: C
authors.lastname: Trinquand
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D003228:Conjunctiva / Q000276:immunology; D003231:Conjunctivitis / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D005469:Fluorometholone / Q000009:adverse effects / Q000627:therapeutic use*; D005901:Glaucoma / Q000150:complications / Q000188:drug therapy; D006684:HLA-DR Antigens / Q000378:metabolism; D006801:Humans; D007213:Indomethacin / Q000009:adverse effects / Q000627:therapeutic use*; D007634:Keratitis / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000627:therapeutic use; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D006684:HLA-DR Antigens; D009883:Ophthalmic Solutions; D005469:Fluorometholone; D007213:Indomethacin