This article is more than 5 years old. Information may no longer be current.
Side effects of BAK in glaucoma medications lead to poor outcomes in filtration surgery
Click Here to Manage Email Alerts
COPENHAGEN, Denmark — The side effects of benzalkonium chloride are not only a major cause of failure of adherence and persistence in glaucoma therapy, but they also greatly decrease the success rate of filtration surgery, according to a specialist speaking here.
“An under-recognized and underestimated side effect of BAK is the induction of chronic conjunctival inflammation and subsequent fibrosis, which is the main reason for failure in trabeculectomy,” Elisabeth Messmer, MD, said at the European Glaucoma Society meeting.
In a study by Baudouin and colleagues, evaluation of inflammatory infiltrates, fibroblasts and connective tissues in biopsies during trabeculectomy showed a major difference between patients who had primary surgery and patients who had been treated with glaucoma medications for a long time.
Other studies looked at the outcomes of surgery and found that untreated eyes had a significantly better prognosis following trabeculectomy compared with eyes in which medical treatment had been administered. It was also proven that with a longer duration of treatment and a higher number of topical medications, there was a higher rate of failure.
“Broadway and co-authors analyzed the outcomes of filtration surgery in 124 patients. Success rate was 90% in those who had primary surgery and gradually dropped to 45% in patients who were on three medications,” Messmer said.
Discontinuation of anti-glaucoma drugs and treatment with steroids is mandatory for patients who need filtration surgery, she said.
References:
- Baudouin C, Pisella PJ, Fillacier K, et al. Ocular surface inflammatory changes induced by topical antiglaucoma drugs: human and animal studies. Ophthalmology. 1999;106(3):556-563.
- Broadway DC, Grierson I, O’Brien C, Hitchings RA. Adverse effects of topical antiglaucoma medication. II. The outcome of filtration surgery. Arch Ophthalmol. 1994;112(11):1446-1454.
For more information:
- Disclosure: Messmer has no relevant financial disclosures.