Ocular Surface Optimised Glaucoma Surgery: Best Clinical Practice

There is a need to optimise the health of the ocular surface prior to filtration glaucoma surgery. Poor ocular surface in glaucoma patients arises due to the complex interaction between topical glaucoma medications and the micro-architecture of the conjunctiva. The long-term and frequent use of active ingredients and preservatives such as benzalkonium chloride results in the depletion of goblet cells, reduction of basal tear turnover rate and promotes development of ocular allergy. The effect on the conjunctiva if left unchecked provides an inhospitable environment for filtration surgery (FS). Maintaining the health of the ocular surface and conjunctiva is a highly modifiable risk factor to promote the success of FS  and functioning bleb.

At present there are no peer-reviewed, validated guidelines providing clinicians in the United Kingdom with a standard operating procedure on mitigating the effects of glaucoma treatment related ocular surface disease (GTROSD)

Review of current literature using PUBMED for the treatment of ocular surface disease. We propose an algorithm for the assessment of the OS and treatment strategies to aid ophthalmologists preparing the OS for bleb-forming procedures.

Our proposed algorithm provides a clear treatment flowchart as an aide for all practicing clinicians.  This algorithm can be used to guide the pre-operative assessment and provides stepwise non-pharmacological and pharmacological approach to the ocular surface.

By optimising the ocular surface with clear pre-operative, intra-operative, and post-operative considerations, rates of success for FS are maximised, with a substantive reduction in common post-operative side effects