Be aware of glaucoma therapy-related ocular surface disease when planning filtration surgery!

Glaucoma eye drops, especially when containing preservatives, are responsible for clinical or subclinical ocular surface alterations (1). Amongst other negative consequences, the so-called glaucoma therapy-related ocular surface disease (2) may i) increase the probability of needing glaucoma surgery, most likely due to medication intolerance (3), and ii) increase the risk of surgical failure (1,4). Indeed, preoperative conjunctival inflammation is associated with an exaggerated wound healing process leading to bleb scarring and filtration failure (1).

A preoperative medical “preparation” of the ocular surface, including a one-month course of low-potency topical steroid, has been shown to improve the outcomes of filtering surgery (5). This preoperative protocol may be tailored to each patient and combined with artificial tears and/or even partial or complete withdrawal of (preserved) glaucoma eye drops, that can be replaced, if needed, by oral acetazolamide.

Contributor: Antoine Rousseau, MD. Department of Ophthalmology, Bicêtre Paris-Saclay University Hospital, France

References
1. Baudouin C, Kolko M, Melik-Parsadaniantz S, Messmer EM. Inflammation in Glaucoma: From the back to the front of the eye, and beyond. Prog Retin Eye Res. 2021 Jul;83:100916.
2. Banitt M, Jung H. Ocular Surface Disease in the Glaucoma Patient. Int Ophthalmol Clin. 2018 Summer;58(3):23-33.
3. Chamard C, Larrieu S, Baudouin C, Bron A, Villain M, Daien V. Preservative-free versus preserved glaucoma eye drops and occurrence of glaucoma surgery. A retrospective study based on the French national health insurance information system, 2008-2016. Acta Ophthalmol. 2020 Nov;98(7):e876-e881.
4. Boimer C, Birt CM. Preservative exposure and surgical outcomes in glaucoma patients: The PESO study. J Glaucoma. 2013 Dec;22(9):730-5.
5. Breusegem C, Spielberg L, Van Ginderdeuren R, Vandewalle E, Renier C, Van de Veire S, Fieuws S, Zeyen T, Stalmans I. Preoperative nonsteroidal anti-inflammatory drug or steroid and outcomes after trabeculectomy: a randomized controlled trial. Ophthalmology. 2010 Jul;117(7):1324-30.

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