ÖZET
Amaç: Oftalmik solüsyonlarda siklikla kullanilan bir prezervatif olan benzalkonyum klorürün oküler yüzey ve gözyasi filmi fonksiyonlari üzerindeki toksik etkisini ve bu etkinin geri dönüsebilirligini incelemek.
Gereç ve Yöntem: Çalismaya primer açik açili glokom (PAAG) veya oküler hipertansiyon (OHT) nedeniyle timolol maleat (%0.5) kullanan 19 hastanin 38 gözü çalismaya alindi. Gözyasi filmi fonksiyonlari ve oküler yüzey degisiklikler Schirmer I testi, floresein kirilma zamani (FKZ), rose bengal ile boyanma, impresyon sitolojisi ile degerlendirildi. Daha sonra medikasyon prezervansiz timolol maleat ile degistirildi ve bütün testler 1. ve 2. aylarda tekrarlandi. Ayrica her takipte hastalarin göziçi basinci (GIB) ölçüldü.
Bulgular: Prezervanli timolol maleat kullanirken Schirmer I testi ortalamasi 7.05 mm/5dak idi (p<0.002). Hastalar prezervansiz damlaya geçildikten sonra 9.8 mm/5 dk'ya yükseldi. Baslangiçta FKZ 8.29 sn idi ve prezervansiz damla kullanirken 13.18 sn'ye ulasti (p<0.01). Hastalar prezervan içeren göz damlasi kullanirken gözlerin %19'u rose bengal ile boyandi, prezervansiz damla kullaniminin 2. ayinda %5 düzeyine düstü (p=0.001). Prezervanli timolol maleat kullanilan dönemde impresyon sitolojisi incelemesi gözlerin %50'sinin evre 0'da oldugunu gösterdi. Prezervansiz damla kullanimindan 2 ay sonra %76.3'e yükseldi (p=0.02). Prezervanli ve prezervansiz medikasyonlar arasinda etkinlik olarak anlamli fark yoktu (p>0.05).
Sonuç: Kronik benzalkonyum klorür maruziyeti gözyasi filmi fonksiyon testlerinde bozulma, oküler yüzey biyolojik boyanmasinda artis, konjonktivada skuamoz metaplazi ve goblet hücre kaybi ile sonuçlanmaktadir. Bütün bu degisiklikler prezevansiz damlaya geçildikten sonra normale dönmeye baslamaktadir.
Anahtar Kelimeler: Benzalkonyum klorür, Gözyasi fonksiyon testleri, Oküler yüzey, Skuamoz metaplazi
Toxic Effect of Preservative Material in Ophthalmic
Solutions on Tear Functions and Ocular Surface
SUMMARY
Purpose: To investigate the toxic effect of benzalkonium chloride, a preservative that is commonly used in ophthalmic solutions, on ocular surface and on tear film functions and also reversibility of this effect.
Material and Method: Tshirtyeight eyes of 19 patients using timolol maleat (0.5%) because of primary open angle glaucoma (POAG) or ocular hipertension were included in the study. The changes in the tear film functions and the ocular surface were evaluated by Schirmer I test, fluorescein break up time (BUT), rose bengal stainning and impression cytology. Then the medication was switched to preservative free timolol maleat and all tests were repeated at 1st and 2nd months. In addition intraocular pressures were measured at each follow up.
Results: The mean of Schirmer I tests while using timolol maleat with preservative was 7.05 mm/5 min. It increased to 9.8 mm/5 min when patients were switched to preservative free drop (p<0.002). At the beginning the fluorescein BUT was 8.29 sec and was increased to 13.18 sec while using preservative free drop (p<0.01). While 19% of the eyes were stainned with rose bengal when the patients were using preservative containing eye drop, it decreased to the level of 5% at the 2nd month of preservative free drop usage (p=0.001). Impression cytology evaluation showed that 50% of the eyes were at stage 0 while using timolol maleat with preservative. It increased to 76.3% after 2 months of preservative free drop usage (p=0.02). There was no significant difference between the effectiveness of medications with and without preservative (p>0.05).
Conclusion: Chronic exposure to benzalkonium chloride results in worsenning of tear film function tests increase in biological stainning of ocular surface, squamous metaplasia in conjunctiva and loss of goblet cells. All these changes reverse to normal after switching to preservative free drop
Key Words: Benzalkonium chloride, Tear film function tests, Ocular surface, Squamous metaplasia
