title: Changes in the morphological and functional patterns of the ocular surface in patients treated with prostaglandin analogues after the use of TSP 0.5%® preservative-free eyedrops: a prospective, multicenter study.
abstract: OBJECTIVE
  To investigate and compare the effects of topical benzalkonium chloride-preserved prostaglandins (PGAs) on the ocular surface in patients with primary open-angle glaucoma before and after 3 months of treatment with additional 0.5% preservative-free tamarind seed polysaccharide single-dose eyedrops (TSP®, Oftagen, Pisa, Italy).
  
  
  METHODS
  This was a prospective, longitudinal, multicenter study. From 5 different Italian glaucoma centers, 10 glaucomatous patients were recruited in each center. All the patients were treated with a PGA with preservative for at least 1 year. Preservative-free artificial tears 3 times per day were prescribed. The participants were subjected to clinical and instrumental evaluation at baseline, after 1 month and after 3 months of treatment. All patients were examined with a digital corneal confocal laser scanning microscope (HRT II Rostock Cornea Module).
  
  
  RESULTS
  After 3 months of TSP 0.5% treatment, an improvement of some ocular signs and symptoms was found. The percentage of conjunctival hyperemia decreased from 67 to 13%. Schirmer's test and breakup time significantly changed from the baseline after 3 months. Confocal microscopy showed a significant increase in conjunctival goblet cells.
  
  
  CONCLUSIONS
  Artificial substitutes, in particular TSP 0.5%, might protect the ocular surface hence giving higher compliance, adherence and quality of life to the patients.
authors.affiliation: Laboratorio clinico anatomo-funzionale per la diagnosi e il trattamento del glaucoma e della malattie neurooftalmologiche, Clinica Oculistica, DiNOGMI, University of Genoa, Genoa, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Iester
authors.forename: Francesco
authors.initials: F
authors.lastname: Oddone
authors.forename: Paolo
authors.initials: P
authors.lastname: Fogagnolo
authors.forename: Paolo
authors.initials: P
authors.lastname: Frezzotti
authors.forename: Michele
authors.initials: M
authors.lastname: Figus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003228:Conjunctiva / Q000098:blood supply / Q000187:drug effects; D003315:Cornea / Q000187:drug effects; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D006940:Hyperemia / Q000473:pathology; D007558:Italy; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000627:therapeutic use*; D008517:Phytotherapy / Q000379:methods*; D028321:Plant Preparations / Q000627:therapeutic use*; D011446:Prospective Studies; D011453:Prostaglandins / Q000627:therapeutic use*; D029861:Tamarindus; D013666:Tears / Q000378:metabolism
chemical_list: D009883:Ophthalmic Solutions; D028321:Plant Preparations; D011453:Prostaglandins