Iatrogenic glaucoma therapy failure: the adverse effects of topical antiglaucoma medication treatment outcome

Abstract

Glaucoma, a group of eye diseases that share a characteristic pattern of deterioration of the optic nerve, is a leading cause of blindness internationally. The treatment options for this optic neuropathy continue to remain limited considering that patients may become refractory to either medical therapy or surgical intervention. The initial treatment of choice for most ophthalmologists is topical medical therapy. The goal of medical therapy is to reduce the intraocular pressures in an effort to either halt or slow the progressive deterioration of the optic nerve. However, topical therapy causes a spectrum of cellular responses that may lead to chronic conjunctivitis after the use of multimedication and/or long-term therapy. This chronic conjunctivitis may not only lead to intolerance to therapy, but is also attributed to a significant proportion of trabeculectomy failures due to scarring of the bleb. Since incisional surgery is a primary option for long-term management of glaucoma, particularly those patients with end-stage disease, it is important to investigate the presence of topical drug- mediated inflammation and its effects on further surgical failure.

Keywords::

• β-blocker
• conjunctival bleb
• glaucoma
• prostaglandin analogue
• trabeculectomy

Financial & competing interests disclosure

E Higginbotham has accepted honoraria and reimbursement for travel from Pfizer, Alcon, Vistakon and Allergan. She has also been an investigator for clinical trials supported by Pfizer, Alcon, Allergan and the National Eye Institute (Ocular Hypertension Treatment Study). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

Data from [21].