Use of local non-preservative agents in the treatment of glaucoma

Relevance Most topical hypotensive agents used to treat glaucoma contain preservatives in varying concentrations [1–3]. With prolonged use of topical therapy, patients with glaucoma may develop dry eye syndrome (DES) or toxic-allergic conjunctivitis of varying severity. Currently, new topical preservative-free agents have been developed to reduce the number of side effects during long-term hypotensive therapy: Brimonidine 0.2% and a fixed combination of dorzolamide and timolol [4, 5]. Objective To conduct a comparative analysis of the hypotensive effect and tolerability of topical preservative-free drugs in glaucoma therapy. Material and methods The study was conducted in a group of 60 patients (60 eyes) with drug-induced normalization of intraocular pressure against the background of the use of hypotensive agents. The first group included 30 patients (30 eyes) who underwent replacement of dorzolamide + timolol or brinzolamide + timolol combination with a fixed combination drug without a preservative. The second group also included 30 patients (30 eyes) who underwent replacement of Brimonidine with a preservative-free analogue. Corneal-compensated intraocular pressure was measured before the drug was changed and 1 month after using antihypertensive drugs. Tolerability of the new preservative-free therapy was assessed using a special questionnaire and biomicroscopy of the ocular surface. Results The change of standard local antihypertensive therapy to preservative-free in both groups of patients was accompanied by a decrease in complaints and symptoms characteristic of dry eye syndrome and toxic-allergic conjunctivitis. At the same time, the average total score characterizing drug intolerance, when assessed by the patient, decreased by 2.4 times, and by the attending physician - by 1.9 times. Also in the second group of patients using Brimonidine, a decrease in the level of corneal-compensated intraocular pressure was noted (p < 0.05). In the first group of patients who used a fixed combination of dorzolamide and timolol, the level of corneal-compensated intraocular pressure remained unchanged (p > 0.05). Conclusion The use of preservative-free forms of drugs in the treatment of patients with glaucoma is justified both as initial therapy and as a replacement for current therapy. Key words: glaucoma; ophthalmotonus; intraocular pressure; preservative-free therapy