ADVERSE-EFFECTS OF TOPICAL ANTIGLAUCOMA MEDICATION .1. THE CONJUNCTIVAL CELL PROFILE

Objective: To determine the effect of various longterm topical antiglaucoma regimens on the cell population profile of the conjunctiva. Methods: Conjunctival biopsy specimens from 124 patients undergoing filtration surgery were assessed quantitatively by light microscopy. Preoperatively, the patients had used a drug for only a brief period (group A; n=28), a beta-blocker alone (group B; n=31), a beta-blocker in combination with a miotic (group C; n=33), or a combination of beta-blocker, miotic, and sympathomimetic (group D; n=32). Results: The conjunctiva in groups A and B was similar. Group C conjunctiva differed, but the changes were most marked in biopsy specimens from patients in group D, where there was a significant decrease in goblet cells (P<.05); increase in pale cells, macrophages, and lymphocytes within the epithelium (P<.001); and increase in fibroblasts (P<.001), macrophages (P<.001), mast cells (P<.O5), and lymphocytes (P=.01) in the substantia propria. In addition, the effect of duration of therapy was assessed. Administration of topical medication for more than 3 years was found to increase the numbers of pale cells within the epithelium (P<.05); fibroblasts (P<.05), macrophages (P<.001), lymphocytes (P<.01), and mast cells (P=.001) within the superficial substantia propria; and the numbers of fibroblasts (P=.01) and macrophages (P<.05) within the deep substantia propria. Conclusions: The compared treatment regimens affected the conjunctiva to different degrees, with multiple-drug topical therapy exerting the greatest effect on the degree of subclinical inflammation within the conjunctiva. The results also indicated that administration of topical medication, irrespective of type, for 3 years or more induced a significant degree of subclinical inflammation.