Topical cyclosporine to control ocular surface disease in patients with chronic glaucoma after long-term usage of topical ocular hypotensive medications

• Published in: Eye (London) Vol. 29; no. 6; pp. 808 - 814
• Main Authors: Saini, M, Dhiman, R, Dada, T, Tandon, R, Vanathi, M
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-06-2015; Nature Publishing Group
• Subjects: 692/699/3161/3163; Administration, Topical; Adult; Aged; Antihypertensive Agents - therapeutic use; Chronic Disease; Clinical Study; Cornea - innervation; Cyclosporine - therapeutic use; Drug Combinations; Female; Glaucoma; Glaucoma - drug therapy; Glaucoma - physiopathology; Humans; Immunosuppressive Agents - therapeutic use; Intraocular Pressure - drug effects; Laboratory Medicine; Male; Medicine; Medicine & Public Health; Microscopy, Confocal; Middle Aged; Nerve Fibers - drug effects; Nerve Fibers - physiology; Ophthalmic Solutions; Ophthalmology; Pharmaceutical Sciences/Technology; Prospective Studies; Surgery; Surgical Oncology; Trigeminal Nerve - drug effects; Trigeminal Nerve - physiopathology; Trigeminal Nerve Diseases - drug therapy; Trigeminal Nerve Diseases - physiopathology; Visual Acuity - drug effects; Young Adult
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/eye.2015.40

Purpose
To evaluate changes in ocular surface and central corneal sub-basal nerve fiber layer (SBNFL) after topical cyclosporin therapy in chronic glaucoma patients on long-term topical antiglaucoma therapy.
Methods
A prospective comparative study of ocular surface evaluation of chronic glaucoma patients on long-term topical therapy treated concurrently with a topical cyclosporine 0.05% twice daily for 6 months and controls was done. The study parameters evaluated at recruitment and at the 6-month follow-up included details of topical antiglaucoma medications, visual acuity, intraocular pressure, ocular surface evaluation parameters (TBUT, Schirmers I, ocular surface staining scores and ocular surface disease (OSD) index score (OSDI)), central corneal sensation (Cochet Bonnett aesthesiometer), and central confocal microscopy to study the SBNFL density (SBNFLD).
Results
Thirty-two eyes of 16 patients with chronic glaucoma and 30 eyes of 15 normal subjects as controls were studied. Mean TBUT, pre/post CsA treatment was 8.67±3.01/12.24±1.83 s (
P
=0.007). Mean conjunctival/corneal staining scores pre/post CsA treatment were 3.38±1.93/1.50±0.718 (
P
=0.00) /5.19±1.82/1.81±0.78 (
P
=0.098), respectively. Mean OSDI pre/post CsA treatment scores were 30.63±14.61/14.76±6.06 (
P
=0.007). Mean corneal sensations scores pre/post CsA treatment were 4.64±0.46/4.94±0.39 (
P
=0.002). Central corneal SBNFLD pre and post CsA treatment was 8811.35±2985.29/10335.13±4092.064 
μ
m/mm
2
(
P
=0.0001).
Conclusions
Schirmer’s test, ocular surface staining scores, OSDI, corneal sensations, and corneal SBNFLD showed a statistically significant improvement following a 6-month concurrent topical CsA therapy.