title: The Ocular Surface in Medically Controlled Glaucoma: An In Vivo Confocal Study.
abstract: OBJECTIVE
  To study clinical and in vivo laser scanning confocal microscopy (LSCM) ocular surface findings in stable, medically controlled primary open-angle glaucoma (MCPOAG) patients.
  
  
  METHODS
  We recruited 100 consecutive patients with MCPOAG and 50 healthy controls. Patients had to have been treated with the same medical regimen without variation for the 18 months before enrollment and were excluded if there was a history of dry eye prior to glaucoma diagnosis. Each participant underwent ocular surface clinical and LSCM examination.
  
  
  RESULTS
  In MCPOAG patients, subbasal nerve length and tortuosity and dendritic cell density were increased compared to controls (P < 0.01), but there were no clinical abnormalities. Patients treated with preserved drugs (n = 80) had reduced tear film breakup time (P < 0.05, ANOVA), and those preserved with benzalkonium chloride (n = 72) had reduced Schirmer test values (P < 0.001). Patients (n = 50) treated with two or more drugs had increased lissamine green conjunctival staining (P < 0.001, LSD post hoc test). Patients (n = 29) treated with three or more eye drops daily had decreased Schirmer test values. Laser scanning confocal microscopy showed subbasal changes related to preservatives, type and number of drugs, and number of eye drops.
  
  
  CONCLUSIONS
  In stable MCPOAG patients without dry eye history, the ocular surface changes due to antiglaucoma medications are mostly subclinical. Active ingredients, preservatives, number of concomitant drugs, and number of eye drops instilled per day are all elements that can induce ocular surface changes. The clinical relevance of these changes remains to be determined.
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy 2Eye Clinic San Giuseppe Hospital, Milan, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Villani
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy 2Eye Clinic San Giuseppe Hospital, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Sacchi
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy 3Fondazione IRCCS Ca' Granda Policlinico, Milan, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Magnani
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy 3Fondazione IRCCS Ca' Granda Policlinico, Milan, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Nicodemo
authors.affiliation: Division of Ophthalmology, Department of Neurosciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Susan E I
authors.initials: SE
authors.lastname: Williams
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy 3Fondazione IRCCS Ca' Granda Policlinico, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy 3Fondazione IRCCS Ca' Granda Policlinico, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Ratiglia
authors.affiliation: Eye Clinic Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy 6Eye Clinic San Paolo Hospital, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: De Cillà
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy 2Eye Clinic San Giuseppe Hospital, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Nucci
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002452:Cell Count; D003228:Conjunctiva / Q000187:drug effects / Q000473:pathology; D003315:Cornea / Q000187:drug effects / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure; D000069416:Intravital Microscopy / Q000379:methods*; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods; D008875:Middle Aged; D009883:Ophthalmic Solutions
chemical_list: D000959:Antihypertensive Agents; D009883:Ophthalmic Solutions