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document
[ Structural and immunohistochemical changes of conjunctiva induced by topical glaucoma medication ] . PURPOSE The topical medication represents the first line therapy for the primary open angle glaucoma . The study is aimed at assessing the structural and immunohistochemical changes of conjunctiva induced by topical glaucoma medication . METHODS For this purpose , we carried out a 40 weeks , prospective , experimental , epidemiological-operational and randomized study enrolling 18 patients ( 36 eyes ) with recently primary open angle glaucoma . The eyes were divided into treatment ( non-selective beta blockers or selective , prostaglandin analogues , topical carbonic anhydrase inhibitors ) in four groups . The assessment was performed by comparison with control group ( 4 patients ) who was instilled with natural tears ( with different preservative ) . Both the cytology and the conjunctival biopsy specimens were investigated by histological exams and immunohistochemistry using different monoclonal antibodies . The study was performed by collaboration with The National Institute of Research and Development in Pathology and Biomedical Sciences- " V. Babes " -Bucharest . RESULTS The morphometric analysis of histological sections of conjunctiva showed the following changes : squamous metaplasia ( significant increases in the thickness and number of epithelial cell layers ) , inflammation ( increase the number of lymphocytes , macrophages and fibroblasts ) and subconjunctival fibrosis . According to the type of medication , we observed the significant increase of subepithelial collagen density and degenerative changes of fibrocytes , the reduction of extracellular matrix and also the up-regulation of antibodies against matrix metalloproteinase and allergic changes . According to structural changes , the immunohistochemistry confirmed the tendency of chronic inflammation . CONCLUSIONS This study revealed important structural and immunohistochemical changes of conjunctiva after topical glaucoma medication . The category and the intensity of these changes are dependent on the sort of therapy and the topical treatment period . The findings showed that benzalkonium chloride ( the most common preservative of antiglaucoma drugs ) is a major factor for conjunctival metaplasia .
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Intervention_Physical
topical medication
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Intervention_Physical
topical glaucoma medication
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Intervention_Pharmacological
non-selective beta blockers or selective , prostaglandin analogues , topical carbonic anhydrase inhibitors
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Intervention_Control
control
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Intervention_Physical
natural tears
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Intervention_Physical
topical glaucoma medication
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Intervention_Pharmacological
benzalkonium chloride ( the most common preservative of antiglaucoma drugs )
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Outcome_Physical
squamous metaplasia
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Outcome_Physical
thickness and number of epithelial cell layers ) , inflammation
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Outcome_Physical
number of lymphocytes , macrophages and fibroblasts ) and subconjunctival fibrosis .
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Outcome_Physical
subepithelial collagen density and degenerative changes of fibrocytes , the reduction of extracellular matrix and also the up-regulation of antibodies against matrix metalloproteinase and allergic changes .
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Outcome_Physical
chronic inflammation .
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Outcome_Physical
conjunctiva
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Participant_Sample-size
18 patients
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Participant_Condition
primary open angle glaucoma
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Participant_Sample-size
4 patients
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Participant_Condition
natural tears