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Introduction: Glaucoma medications are often preserved with agents such as benzalkonium chloride, which commonly lead to ocular surface diseases.Purpose: To investigate the effect of switching to a preservative-free prostaglandin analogue, tafluprost 0.0015% on treatment tolerability and ocular surface diseases.Study design: This was a prospective, open-label, non-randomised, observational study performed in a single hospital.Materials and methods: This study involved patients of Asian descent diagnosed with primary open-angle glaucoma and ocular hypertension (n = 28), who received preserved prostaglandin monotherapy for longer than 3 months and had a National Eye Institute ocular surface staining scale score higher than 1. Patients were switched from preserved prostaglandin monotherapy to preservative-free tafluprost 0.0015%. Patients were analysed at baseline (Visit 0), 1 month (Visit 1), and 3 months (Visit 2). The main parameter measured is the change in the fluorescein staining score at Visit 2.Results: There was a significant improvement in the fluorescein staining score, with a mean reduction score of 1.96 (standard deviation, SD = 1.53; p < 0.0001), and significant reductions in conjunctival hyperaemia (bulbar, p < 0.0001; palpebral, p < 0.05) from baseline to Visit 2. The Ocular Surface Disease Index questionnaire also showed a mean reduction of 4.14 from baseline to visit 2 (SD = 8.20; p < 0.05). The intraocular pressure and tear breakup time were maintained from baseline to Visit 2.Conclusion: Switching patients to preservative-free tafluprost 0.0015% showed significant improvements in ocular surface disease with minimal side effects and similar intraocular pressure reduction rates.

Joseph Anthony Tumbocon,1,2 Tina T Wong,3– 5 Thanendthire Sangapillai,6 Yung-Chang Yen,7 Sang-Woo Park,8 Hsien Han Lim,9 Ngamkae Ruangvaravate10 1Eye Institute, St. Luke’s Medical Center, Quezon City, Philippines; 2Department of Ophthalmology, St. Luke’s Medical Center College of Medicine, Quezon City, Philippines; 3Glaucoma Department, Singapore National Eye Centre, Singapore, Singapore; 4Cataract & Comprehensive Ophthalmology Department, Singapore Eye Research Institute, Singapore, Singapore; 5Ophthalmology & Visual Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore; 6Tun Hussein Onn National Eye Hospital, Petaling Jaya, Selangor, Malaysia; 7Department of Ophthalmology, Chi Mei Medical Center, Tainan City, Taiwan; 8Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, South Korea; 9Eye Centre, Sunway Medical Centre, Petaling Jaya, Selangor, Malaysia; 10Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Joseph Anthony Tumbocon, Eye Institute, St. Luke’s Medical Center, 279 E Rodriguez Sr. Ave, Quezon City, Metro Manila, 1112, Philippines, Email jatumbocon@gmail.comBackground: Preserved prostaglandin analogs (PGAs) have been linked to ocular surface disease (OSD). While the benefits of preservative-low (PL) or -free (PF) Tafluprost (Santen Inc., Japan) were reported in real-world studies in Western countries, this is the first study in Asia to assess the effectiveness and safety of switching from preserved PGA to PL or PF-Tafluprost.Methods: We conducted a meta-analysis on studies that included adults (> 18 years of age) with a Corneal Fluorescein Staining Score (CFS) > 1. These individuals had switched to PL or PF-tafluprost after using a preserved PGA therapy for at least 3 months for glaucoma and were identified from Santen’s tafluprost study database. A total of six studies from South Korea, Philippines, Malaysia, Singapore, Thailand, Taiwan were pooled for analysis.Results: An intraocular pressure (IOP) reduction of 5.9% (0.91 mmHg) was seen in 265 patients. However, this result was not statistically significant (95% CI: − 3.64, 1.81; Figure 1). Among 132 patients, a 47.9% reduction in the CFS (95% CI: − 3.65, − 1.91) was seen. Tear film break-up (n=183) significantly increased by 1.06 seconds (95% CI: 0.65, 1.47). In 88 patients, the bulbar conjunctiva score decreased by − 0.46 (95% CI: − 0.81, − 0.10) and palpebral conjunctiva score decreased by − 0.42 (95% CI: − 0.67– 0.17). One or more new adverse reactions were reported in 3% of the individuals after switching.Conclusion: Tafluprost IOP reduction is comparable to other PGAs, with significant improvements in the ocular surface and minimal adverse reactions which were already previously reported.Keywords: ocular surface disease, glaucoma, preserved prostaglandins, tafluprost, PGA, preservative-free, preservative-low, Asian population, meta analysis