title: Therapeutic Effects of Sodium Hyaluronate on Ocular Surface Damage Induced by Benzalkonium Chloride Preserved Anti-glaucoma Medications.
abstract: BACKGROUND
  Long-term use of benzalkonium chloride (BAC)-preserved drugs is often associated with ocular surface toxicity. Ocular surface symptoms had a substantial impact on the glaucoma patients' quality of life and compliance. This study aimed to investigate the effects of sodium hyaluronate (SH) on ocular surface toxicity induced by BAC-preserved anti-glaucoma medications treatment.
  
  
  METHODS
  Fifty-eight patients (101 eyes), who received topical BAC-preserved anti-glaucoma medications treatment and met the severe dry eye criteria, were included in the analysis. All patients were maintained the original topical anti-glaucoma treatment. In the SH-treated group (56 eyes), unpreserved 0.3% SH eye drops were administered with 3 times daily for 90 days. In the control group (55 eyes), phosphate-buffered saline were administered with 3 times daily for 90 days. Ocular Surface Disease Index (OSDI) questionnaire, break-up time (BUT) test, corneal fluorescein staining, corneal and conjunctival rose Bengal staining, Schirmer test, and conjunctiva impression cytology were performed sequentially on days 0 and 91.
  
  
  RESULTS
  Compared with the control group, SH-treated group showed decrease in OSDI scores (Kruskal-Wallis test: H = 38.668, P < 0.001), fluorescein and rose Bengal scores (Wilcoxon signed-ranks test: z = -3.843, P < 0.001, and z = -3.508, P < 0.001, respectively), increase in tear film BUT (t-test: t = -10.994, P < 0.001) and aqueous tear production (t-test: t = -10.328, P < 0.001) on day 91. The goblet cell density was increased (t-test: t = -9.981, P < 0.001), and the morphology of the conjunctival epithelium were also improved after SH treatment.
  
  
  CONCLUSIONS
  SH significantly improved both symptoms and signs of ocular surface damage in patients with BAC-preserved anti-glaucoma medications treatment. SH could be proposed as a new attempt to reduce ocular surface toxicity, and alleviate symptoms of ocular surface damage in BAC-preserved anti-glaucoma medications treatment.
authors.affiliation: Department of Glaucoma, The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, China.
authors.forename: Xing
authors.initials: X
authors.lastname: Liu
authors.forename: Fen-Fen
authors.initials: FF
authors.lastname: Yu
authors.forename: Yi-Min
authors.initials: YM
authors.lastname: Zhong
authors.forename: Xin-Xing
authors.initials: XX
authors.lastname: Guo
authors.forename: Zhen
authors.initials: Z
authors.lastname: Mao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001548:Benzalkonium Compounds / Q000009:adverse effects*; D015352:Dry Eye Syndromes / Q000139:chemically induced / Q000517:prevention & control; D005123:Eye / Q000187:drug effects*; D005131:Eye Injuries / Q000139:chemically induced / Q000517:prevention & control*; D005260:Female; D005901:Glaucoma / Q000188:drug therapy*; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D001548:Benzalkonium Compounds; D006820:Hyaluronic Acid