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Purpose: The aim of this study was to evaluate the ocular surface in patients treated with prostaglandin analogues considering contained preservative agent., Methods: 60 patients with glaucoma or ocular hypertension treated with prostaglandin analogue monotherapy were enrolled in this observational study. 20 patients with glaucoma suspect or ocular hypertension without local or systemic glaucoma medication formed the control group. Demographic data and medical history were recorded for each participant. Patients filled in the Ocular surface disease index© (OSDI) questionnaire and underwent an ophthalmological examination including assessment of conjunctival hyperaemia according to Efron, tear film break up time (BUT) and fluorescein staining according to the Oxford grading scheme. Treated participants were divided into 3 groups according to the preservative contained in the currently used prostaglandin analogue: the preservative-free group (18 patients), the polyquaternium group (17 patients) and the benzalkonium chloride (BAK) group (25 patients)., Results: The control group had significantly lower fluorescein staining than the preservative-free group (p=0.001), the polyquaternium group (p=0.007) and the BAK group (p=0.002). The conjunctival hyperaemia was significantly lower in the preservative-free group compared to the polyquaternium group (p=0.011). There was no significant difference among the other groups. The difference neither in the OSDI score nor in the BUT was statistically important., Conclusion: This study confirmed that the ocular surface is worse in patients treated with prostaglandin analogue monotherapy than in people without glaucoma medication. A significant difference among treated patients depending on a preservative agent was not proved.Key words: benzalkonium chloride, glaucoma, ocular surface disease, preservatives, prostaglandin analogues.

The author calculated the daily dose of Benzalkonium Chloride (BAC) in eye drops used in glaucoma treatment from the patients point of view, which means the real amount of BAC applied in the conjunctival sac. The information about BAC concentration in 1 milliliter (mL) do not offer sufficient picture about real circumstances, because the size of the drop, especially after the introducing of the use of generic products in clinical practice in specific anti-glaucomatic drugs, differs significantly. The daily dose of BAC may have substantial significance in the patients treatment tolerance. The overview of BAC daily dose in single therapeutic groups and drugs follows: betablockers: Timo-COMOD 0, Arutimol 2.6, Vistagan 2.8, Timolol-POS 3.0, Arteoptic 3.7, Betoptic S 4.8, Timoptol MSD 6.3, Betoptic 10.0; alpha-mimetics: Alphagan 3.5, Luxfen 3.5, Aruclonin 7.1; derivates of prostaglandine, prostamides: Taflotan 0, Monopost 0, Lumigan 1.4, Unilat 3.1, Travatan 3.9, Latanoprost Apotex 4.3, Rescula 5.8, Latanoprost POS 5.9, Xalatan 6.0, Latanoprost Ratiopharm 6.0, Latanoprost Actavis 6.0, Latanoprost Arrow 6.0, Arulatan 5.4, Latalux 6.0, Glaucotens 6.0, Xaloptic 6.0, Solusin 6.1; carboanhydrase inhibitors: Batidor 3.8, Azopt 4.8, Trusopt 5.4, Oftidor 8.1; fixed combinations: Ganfort 1.4, Dorzolamid/timolol TEVA 2.8, Combigan 3.2, Duotrav 4.3, Cosopt 5.6, Xalacom 6.0, Glaucotima 6.0, Latanoprost/timolol Apotex 6.3, Azarga 6.4, Dorzogen Combi 6.5, and Dozotima 8.8 µl.

Preservatives in eye drops, especially benzalkonium chloride (BAC), may act as cytotoxic; furthermore, it may cause the instability of the tear film, conjunctivitis, subconjunctival fibrosis, epithelium apoptosis and worsening the prognosis of possible surgical treatment. The patient's subjective symptoms may decrease his compliance. For better orientation in this issue, the authors calculated the daily BAC doses in eye drops used in the glaucoma treatment. Significant differences are caused by different size of the drop in specific medicament, different BAC concentrations in the volume unit of the package, and frequency of application. The daily BAC doses are in micrograms as follows: Beta-blockers: Timo-COMOD 0.0, Arutimol 2.6, Vistagan 2.8, Timolol POS 3.0, Arteoptic 3.7, Carteol 4.0, Betoptic S 4.8, Timoptol MSD 6.3, Betoptic 10.0. Alpha-mimetics: Alphagan and Luxfen 3.5, Aruclonine 7.1. Prostaglandin derivates, prostamides and docosanoides: Taflotan 0.0, Lumigan 1.4, Unilat 3.0, Travatan 3.9, Rescula 5.8, Xalatan 6.0, Latanoprost-ratiopharm, Xaloptic, Latanoprost Actavis, Latanoprost Arrow, Solusan, Glaucotens 6.0. Carbonic anhydrase inhibitors: Azopt 4.8, Trusopt 5.4. Fixed combinations: Ganfort 1.4, Combigan 3.2, Duotrav 4.3, Cosopt 5.6, Xalacom 6.0.

The authors investigated in a group of 100 eyes the incidence of micro-organisms in the conjunctival sac and on the borders of the eyelids and their sensitivity to antibiotics before planned operations of the eyes. In all instances cultivation at three time intervals was used--on admission, on the morning before operation after administration of antibiotic drops for at least one day, and in the operation theater after careful disinfection of the surgical field. The assembled results indicate the small effectiveness of short-term preoperative administration of disinfectant and antibiotic drops and confirm the high effectiveness of antiseptic preparation of the surgical field.