Prerequisites to Use Preservative-Free Drugs in Medication Therapy of Glaucoma

Purpose — to analyze the literature data on the benefits of preservative-free medication therapy for glaucoma.

Materials and methods. 482 articles in the Pubmed database published from 1975 to 2020 were analyzed using the terms: “glaucoma”, “preservatives”, “preservative-free therapy”, “benzalkonium chloride”. The review includes 78 articles. Inclusion criteria: studies that examined the effect of local antihypertensive therapy on the condition of the ocular surface in comparison with preservative-free drugs.

Discussion. BAC is the most common preservative used in ophthalmology, accounting for 70 % of eye drop formulations. But it has a pronounced toxic effect on the ocular surface, so other classes of preservatives have been developed. These include polyquaternium-1 detergent; oxidizing preservatives — stabilized oxychlorocomplex and sodium perborate; ionic buffer preservative. However, most of the publications are devoted to BAC, as it is considered the most toxic and, at the same time, the most commonly used preservative. There is a large number of switching studies from preservative therapy to preservative-free, in which almost all groups of drugs used for the treatment of glaucoma were studied, but the use of antihypertensive drugs is associated not only with the action of preservatives, but also with the active substance, excipients and buffers. However, most switching studies demonstrate the benefits of preservative-free drugs. Other studies compared preservative and preservative-free drugs with the same active ingredients, in which a comparable hypotensive effect and safety profile was revealed, which indicates that BAC is not required for adequate penetration of the active substance to the point of application. At the same time, statistically significant advantages in the tolerability of preservativefree therapy were also revealed.

Conclusion. Glaucoma preservative therapy has a toxic effect on the ocular surface, which leads to a decrease in the quality of life and compliance. Switching to preservative-free drugs can help reduce iatrogenic complications during long-term treatment of patients with glaucoma

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