Journal of Current Glaucoma Practice

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VOLUME 6 , ISSUE 3 ( September-December, 2012 ) > List of Articles

PERSPECTIVE

Controversy: Is Benzalkonium Chloride Necessary in Antiglaucoma Drops?

Y Louati, T Shaarawy

Keywords : BAK, Ocular surface disease and glaucoma, Bioavailability, Preservatives in glaucoma medication, Preservative free glaucoma medication

Citation Information : Louati Y, Shaarawy T. Controversy: Is Benzalkonium Chloride Necessary in Antiglaucoma Drops?. J Curr Glaucoma Pract 2012; 6 (3):104-107.

DOI: 10.5005/jp-journals-10008-1115

License: CC BY-NC 4.0

Published Online: 01-12-2012

Copyright Statement:  Copyright © 2012; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Medical therapy is the first-line option in glaucoma management, with benzalkonium chloride (BAC) being the most frequently used preservative in antiglaucoma medications. Its use is however, known to be associated with deleterious effects on the ocular surface. This review is an attempt to critically evaluate whether BAC really is indispensable for better bioavailability of antiglaucoma drugs and consequently, better IOP control.


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  1. Noecker RJ. Corneal and conjunctival changes caused by commonly used glaucoma medications. Cornea 2004;23: 490-96.
  2. Bernal D. Quantitative evaluation of the corneal epithelial barrier: Effect of artificial tears and preservatives. Curr Eye Res 1991;10:645-56.
  3. Hopes M. Preservative-free treatment in glaucoma is a sensible and realistic aim for the future. European Ophthalmic Review Glaucoma 2010.
  4. Swan K. Reactivity of the ocular tissues to wetting agents. Am J Ophthalmol 1944;27:118.
  5. Lin PY. Prevalence of dry eye among an elderly Chinese population in Taiwan: The Shihpai Eye study. Ophthalmology 2003;110:1096-1101.
  6. Moss SE. Prevalence and risk factors for dry eye syndrome. Arch Ophthalmology 2000;118:1264-68.
  7. Schaumberg DA. Prevalence of dry-eye syndrome among Us women. Am J Ophthalmology 2003;136:318-22.
  8. Lee AJ. Prevalence and risk factors associated with dry eye symptoms: A population-based study in Indonesia. Br J Ophthalmology 2002;86:1347-51.
  9. Mc Carty CA. The epidemiology of a dry eye in Melbourne, Australia. Ophthalmology 1998;105:1114-19.
  10. Chia EM. Prevalence and associations of dry-eye syndrome in older population: The Blue Mountains Eye study. Clin Experimental Ophthalmol 2003;31:229-32.
  11. Schein OD. Prevalence of dry eye among the elderly. Am J Ophthalmology 1997;124:723-28.
  12. Jaenen N. Ocular symptoms and signs with preserved and preservative-free glaucoma medications. Eur J Ophthalmol 2007;17:341-49.
  13. Hopes M. Preservative-free treatment in glaucoma is a sensible and realistic aim for the future. European Ophthalmic review, Glaucoma 2010.
  14. Broadway DC. Reversal of topical antiglaucoma medication effects on the conjunctiva. Arch Ophthalmol 1996;114:262-67.
  15. Broadway DC, Grierson I, O'Brien C, et al. Adverse effects of topical antiglaucoma medication. I. The conjunctival cell profile. Arch Ophthalmol 1994;112:1437-45.
  16. Baudouin C, Pisella PJ, Fallacier K, et al. Ocular surface inflammatory changes induced by topical antiglaucoma drugs: Human and animal studies. Ophthalmology 1999;106:556-63.
  17. Ariturk N, Oge I, Baris S, et al. The effects of antiglaucomatous agents on conjunctiva used for various durations. Int Ophthalmol 1996;20:57-62.
  18. Broadway DC, Grierson I, O'Brien C, et al. Adverse effects of topicalantiglaucoma medication. II. The outcome of filtration surgery. Arch Ophthalmol 1994;112:1446-54.
  19. Ammar D, Kahook MY. Effects of glaucoma medications and preservatives on cultured human trabecular meshwork and nonpigmented ciliary epithelial cell lines. Br J Ophthalmol 2011;95(10):1466-69.
  20. Alvarado J. Trabecular meshwork cellularity in primary open.angle glaucoma and nonglaucomatous normals. Ophthalmology 1984;91:564-79.
  21. Chandrasekaran S, et al. Associations between elevated intraocular pressure and glaucoma, use of glaucoma medications, and 5-year incident cataract: The Blue Mountains Eye Study. Ophthalmology 2006;113:417-24.
  22. Herman DC, et al. Topical ocular hypotensive medication and lens opacification: Evidence from the ocular hypertension treatment study. Am J Ophthalmol 2006;142:800-10.
  23. Eastly DL. Comparison of a nonpreserved 0.1% T-gel eye gel with preserved 0.1% T-gel eye gel in ocular hypertension and glaucomatous patient. Br J Ophthalmol 2006 May;90(5): 574-78.
  24. Baudouin C. Short term comparative study of topical 2% carteolol with and without BAC in healthy volunteers. Br J Ophthalmol 1998;82:39-42.
  25. Lewis RA, Travoprost BAC-free Study group. Travoprost 0.004% with and without BAC: A comparison of safety and efficacy. J Glaucoma 2007;16:98-103.
  26. Hannu U. Switching from a preserved to a preservative-free prostaglandin preparation ion topical glaucoma medication. Acta Ophthalmologica 2010;88:329-36.
  27. Hamacher T. Efficacy and safety of preserved and preservativefree tafluprost are equivalent in patients with glaucoma or ocular hypertension: Results from pharmacodynamics analysis, Acta Ophthalmologica 2008:86:S242:14-19.
  28. Jaenen N. Ocular symptoms and signs with preserved and preservative-free glaucoma medications. Eur J Ophthalmol 2007;17.
  29. Nordmann JP, et al. Vision related quality of life and topical glaucoma treatment side-effects. Health Qual Life Outcomes 2003;1:75.
  30. Nordmann JP. Vision related quality of life and topical glaucoma treatment side-effects. Health Qual Life Outcomes 2003; 10:1-75.
  31. Levrat F, Pisella PJ, Baudouin C. Clinical tolerance of antiglaucoma eye drops with and without a preservative. Results of an unpublished survey in Europe. J Fr Ophthalmol 1999;22:186-91.
  32. Broadway DC. Reversal of topical antiglaucoma medication effects on the conjunctiva. Arch Ophthalmol 1996;114:262-67.
  33. Hopes M. Preservative-free treatment in glaucoma is a sensible and realistic aim for the future. European Ophthalmic Review 2010;4:23-28.
  34. Clouzeau C. Hyperosmolarity potentiates toxic effects of benzalkonium chloride on conjunctival epithelial cells in vitro. Epub 2012 Apr 6;18:851-63.
  35. Baudouin C. The ocular surface in glaucoma, Cornea, 2009 Oct;8(9 suppl).
  36. Samples JR. The effect of epinephrine and benzalkonium chloride on cultured corneal endothelial and trabecular meshwork cells. Exp Eye Res 1989;49:1-12.
  37. Leung EW. Prevalence of ocular surface disease in glaucoma patients. J Glaucoma 2008;17:350-55.
  38. Pisella PJ. Br J Ophthalmol. Prevalence of ocular symptoms and signs with preserved and preservative free glaucoma medication. 2002 Apr;86(4):418-23.
  39. Miyake K. ESCRS Binkhorst lecture 2002: Pseudophakic preservative maculopathy. J Cataract Refract Surg 2003 Sep;29(9):1800-10.
  40. Miyake K. Enhanced disruption of the blood-aqueous barrier and the incidence of angiographic cystoid macular edema by topical timolol and its preservative in early postoperative pseudophakia. Arch Ophthalmol 2001 Mar;119(3):387-94.
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