Clinical Benefits of Aloe vera Gel in 0.3% Hyaluronate Eyedrops in Glaucoma Therapy-Related Ocular Surface Disease

<b>Background</b>: <i>Aloe vera</i> gel in 0.3% hyaluronate (AV/HA) could mitigate glaucoma therapy-related ocular surface disease (GTOSD). <b>Methods</b>: Thirty-nine patients diagnosed with GTOSD and receiving AV/HA or HA underwent ocular surface disease index (OSDI), Symptom Assessment iN Dry Eye (SANDE), National Eye Institute Visual Function Questionnaire (NEI VFQ)-25 questionnaires, and tear matrix metalloproteinase-9 (MMP-9), break-up time (BUT), corneal fluorescein staining (CFS), Schirmer test I (STI), and bulbar conjunctival hyperemia (BCH) determination. <b>Results</b>: After one month, <i>AV/HA</i> increased BUT (5 (7-4.5) to 7 (8-5.5)) and STI (12 (19.5-8) to 13.5 (20-10)), while it decreased BCH (2.2 (2.3-1.3) to 2.1 (2.2-1.2)) and CFS (3 (4-2) to 2 (3.0-1.5)) (<i>p</i> < 0.001). SANDE and OSDI scores were reduced from 36.18 (38.5-20.5) to 22.91 (31.5-17.21), and 29.5 (32.5-19.5) to 20 (26.5-18) (<i>p</i> < 0.001). <i>HA</i> reduced BCH from 2.75 (3.20-2.15) to 2.25 (2.30-1.90) (<i>p</i> = 0.014) and CFS from 3.5 (5-2.75) to 2.5 (4-2) (<i>p</i> = 0.014), while it increased BUT (<i>p</i> = 0.036). The SANDE score decreased from 28.95 (47.6-20.9) to 26.86 (36.41-19.90) (<i>p</i> = 0.009), whereas the OSDI decreased from 40 (49-19.5) to 29 (42-19.75) (<i>p</i> = 0.005). Any significant change in NEI VFQ-25 was collected. A trend for an MMP-9 immunoassay positivity reduction was observed in AV/HA (0.073). <b>Conclusions</b>: These findings invite considering lubricants enriched with natural anti-inflammatory agents, such as <i>Aloe vera</i>, as a potential adjunctive option to improve the ocular surface in glaucoma.