title: An in vivo confocal microscopy and impression cytology analysis of preserved and unpreserved levobunolol-induced conjunctival changes.
abstract: OBJECTIVE
  To provide an in vivo confocal microscopy (IVCM) and impression cytology analysis of preserved-and unpreserved levobunolol-induced changes of conjunctival epithelium.
  
  
  METHODS
  27 eyes of 27 patients were consecutively randomized to receive preserved or unpreserved levobunolol; all patients had a recent diagnosis of primary open angle glaucoma (POAG) or ocular hypertension and were not previously treated with topical medications. IVCM and impression cytology were performed before and after six months of therapy. Goblet cells density and a conjunctival epithelium regularity index were considered in the IVCM analysis, whereas impression cytology specimens were graded and scored in accordance with Nelson's method.
  
  
  RESULTS
  After six months of therapy, IVCM and impression cytology parameters showed significant differences with respect to baseline in both groups (p<0.001); significant differences were also found between the two groups (p<0.001). The IVCM analysis showed a goblet cells density reduction (61% and 17% from baseline, respectively in group 1 and 2) (p<0.001) and an higher index of epithelial regularity (p<0.001) in both groups; the impression cytology analysis showed an higher score in both groups (p<0.001).
  
  
  CONCLUSIONS
  All the IVCM and impression cytology parameters correlated well with the conjunctival modifications induced by the topical therapy, suggesting the less toxicity of unpreserved drugs.
authors.affiliation: Department of Medicine and Ageing Science, Ophthalmic Clinic, University of Chieti-Pescara - Italy. m.ciancaglini@unich.it
authors.forename: M
authors.initials: M
authors.lastname: Ciancaglini
authors.forename: P
authors.initials: P
authors.lastname: Carpineto
authors.forename: L
authors.initials: L
authors.lastname: Agnifili
authors.forename: M
authors.initials: M
authors.lastname: Nubile
authors.forename: V
authors.initials: V
authors.lastname: Fasanella
authors.forename: M
authors.initials: M
authors.lastname: Lanzini
authors.forename: R
authors.initials: R
authors.lastname: Calienno
authors.forename: L
authors.initials: L
authors.lastname: Mastropasqua
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002452:Cell Count; D003228:Conjunctiva / Q000187:drug effects* / Q000473:pathology; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy*; D020397:Goblet Cells / Q000473:pathology*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D002040:Levobunolol / Q000627:therapeutic use*; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009798:Ocular Hypertension / Q000188:drug therapy; D011310:Preservatives, Pharmaceutical / Q000627:therapeutic use*; D016037:Single-Blind Method
chemical_list: D000319:Adrenergic beta-Antagonists; D011310:Preservatives, Pharmaceutical; D002040:Levobunolol