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Study shows increased surgical failure in glaucoma patients using drops with BAK
Surgical outcomes in patients with glaucoma may be directly related to the use of eye drops containing benzalkonium chloride, according to a new study.
Boimer and colleagues detailed in the Journal of Glaucoma that they studied 128 glaucoma patients who had undergone a trabeculectomy between 2004 and 2006. The researchers recorded the number and type of eye drops used preoperatively and monitored patients for a minimum of 2 years for predetermined surgical failures: inadequate pressure lowering or need for postoperative ocular antihypertensives, laser trabeculoplasty, 5-fluorouracil needling or repeated surgery.
According to the study, surgical success was achieved in 47.7% of patients. The study results also showed that patients who received higher doses of eye drops containing benzalkonium chloride (BAK) experienced surgical failure at a faster rate than patients with less exposure.
"Increased preoperative exposure to ophthalmic solutions preserved with BAK is a risk factor for earlier surgical failure, independent of the number of medications used. This study extends earlier findings of potential adverse effects of ophthalmic preservatives on surgical outcomes to the modern pharmacopeia used in the medical management of glaucoma," the authors concluded.
"Acknowledging the data generated by the Collaborative Initial Glaucoma Treatment Study, there is no impetus to change the current paradigm of treating to maximal tolerated topical drops before surgery; however, [clinicians] managing glaucoma patients may wish to use ocular antihypertensives that are preserved with the less cytotoxic alternatives to BAK. In cases where patients cannot be weaned off of BAK before surgery, consideration could be given to adding an anti-inflammatory or steroid drop 1 month before the operation."
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J Glaucoma. 2013;doi: 10.1097/IJG.0b013e31825af67d.