| Purpose To evaluate the ocular surface morphology and corneal mechanical sensitivity in patients under long-term prostaglandin analogs treatment.Methods A cross-sectional study was performed in the Eye and ENT Hospital of Fudan University from August2011to April2012. A total of20patients with bilateral primary open-angle glaucoma were enrolled, among which10were treated by prostaglandin eye-drops for at least one year, with steady prescription in the recent6months (group A), and the other10were never treated (group B). Corneal sensitivity was assessed using the Cochet&Bonnet esthesiometer. Corneal and conjunctival morphology were examined by in vivo confocal microscope. Two-eye designs model was taken to evaluate the differences between the two groups. Spearman correlation coefficient was taken to investigate the relationship between corneal sensitivity and corneal sub-basal cells.Results The density of corneal basal epithelial cells in group A was significantly higher than that in group B (7009±638cells/mm2vs.6745±482cells/mm2; F=5.22, p<0.05). The results were similar as for the tortuosity of corneal sub-basal nerves (1.71±0.46vs.1.42±0.43; F=7.29, p<0.05), and the grade for activated keratocytes (2.35±0.81vs.1.25±0.44; F=59.67, p<0.01). In contrast, the branches of corneal sub-basal nerves (17.44±2.56mm/mm2vs.19.54±5.02mm/mm2; F=8.22, p<0.05), the density of goblet cells (45±22cells/mm2vs.69±26cells/mm2; F=15.49, p<0.01)and corneal sensitivity (59.50±1.54mm vs.54.25±6.74mm; F=12.08, p<0.01) significantly reduced in group A. Corneal endothelium didn’t present any morphological abnormalities. The reduced corneal sensitivity positively correlated with the density of corneal sub-basal nerves (r=0.379,p=0.016). No correlations were found between corneal sensitivity and the other factors such as the tortuosity, reflectivity of sub-basal nerves, and the density of Langerhans cells or inflammatory cells.Conclusion Significantly morphological alterations in cornea and conjunctiva were found in glaucomatous patients with chronic prostaglandin analogs treatment, except endothelium cells. The corneal sensitivity reduced, which correlated with decreased density of corneal sub-basal nerves. Purpose To evaluate the effect of vitamin A palmitate eye gel on dry eye symptoms, signs and conjunctival goblet cells in patients with long-term treatment of prostaglandin analogs.Methods A prospective cohort study was performed in the EENT Hospital of Fudan University from September2011to October2012. A total of30primary open-angle glaucoma (POAG) or normal tension glaucoma (NTG) patients with long-term application of prostaglandin analogs (PGs) eye-drops were enrolled, and they were divided into3groups randomly. Group A and B were treated twice daily with vitamin A palmitate eye gel or carbomer eye gel, respectively. Group C didn’t receive any artificial tear as control. OSDI score, tear break-up time (TBUT), Schirmer1test (Sit), in vivo confocal microscope (IVCM) were conducted at baseline and months1,3and6. Conjunctival impression cytology (CIC) was examined at baseline and months3and6. ANOVA, Dunnett t test, Bonferroni, Kruskal-Wallis and Pearson correlation tests were used for statistical analysis.Results No significant differences were found among three groups as for OSDI, TBUT, Sit, and the density of conjunctival goblet cells before treatment. The OSDI scores in group A were significantly decreased after the treatment, from18.6±13.4at baseline to7.2±2.58at6M after treatment (F=3.579, p=0.023). The same was shown in group B, from18.7±14.9at baseline to3.3±2.45at6M after treatment (F=5.882, p=0.002). But OSDI in group C didn’t have significant reduction. TBUT in group C was significantly decreased at last follow-up, from6.6±2.63s at baseline to3.6±0.97s at6M after treatment (F=6.115, p=0.002), while TBUT in group A and B didn’t have significant changes. There were no statistical differences among3groups as for Sit results. The results of IVCM study were as follows:the density of conjunctival goblet cells in group A was greatly increased after the treatment, from40.4±22.6cells/mm2at baseline to69.1±27.3cells/mm2at6M after treatment (F=4.889, p=0.038). While in group B, it was slightly increased, from44.4±14.0cells/mm2at baseline to49.8±12.5cells/mm2at6M after treatment (F=0.461, p=0.711). But in group C, the density of goblet cells was significantly decreased, from59.9±15.7cells/mm2at baseline to32.9±14.2cells/mm2at6M after treatment (F=7.453, p=0.001). The impression cytologic study results also showed that the density of goblet cells increased in group A and B and decreased in group C. But no statistically significant differences were found in any of the groups at any of the times evaluated. The density of goblet cells in IVCM showed significant correlation with those tested by CIC (r=0.285, p=0.007).Conclusion Ocular surface irritation symptoms increased and TBUT, density of conjunctival goblet cells decreased in patients with long-term application of PGs eye drops, which could be attenuated by the topical use of vitamin A palmitate eye gel. The agent might be a promising tool to protect ocular surface from the damage caused by anti-glaucoma eye drops.
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