Unraveling the effects of glycerophosphoinositol-enriched hyaluronic acid eyedrops on the ocular surface in glaucoma: a report from the multicenter OSGLA registry

Purpose: To evaluate the effects of 0. 001% glycerophosphoinositol in 0.2% hyaluronate (GPI/HA) vehicle eye drops in patients with glaucoma therapy related-ocular surface disease (GTOSD). Methods: Forty patients diagnosed with GTOSD and receiving GPI/HA or HA 0.2%, underwent ocular surface disease index (OSDI), Symptom Assessment iN Dry Eye (SANDE), National Eye Institute Visual Function Questionnaire (NEI VFQ)-25 questionnaires, and tear matrix metalloproteinase-9 (MMP-9), break-up time (BUT), corneal fluorescein staining (CFS), Schirmer test I (STI), and bulbar conjunctival hyperemia (BCH) determination. Results: After 1 month, GPI/HA eyedrops increased BUT [6 (4–7.25) to 7 (6–8)] and STI [11.5 (8–17.5) to 13.5 (10–18.5)], whereas decreased BCH [2.2 (2.1–2.3) to 2.1 (1.3–2.2)] and CFS [3 (2–4) to 2 (2–3)] (p < 0.001). Questionnaire scores improved from 35 (24.36–46.25) to 33 (20.75–40.52), for SANDE and from 31.5 (20–45) to 28.5 (17.75–40.5), for OSDI (p < 0.001). HA 0.2% eyedrops reduced BCH from 2.75 (2.15–3.20) to 2.25 (1.90–2.30) and CFS from 3.5 (2.75–5) to 2.5 (2–4) (p = 0.014), and increased BUT (p = 0.036). Questionnaire scores improved from 28.95 (20.9–47.6) to 26.86 (19.90–36.41) (p = 0.009) for SANDE, and from 40 (19.5–49) to 29 (19.75–42) (p = 0.005) for OSDI. There were not significant modifications in the MMP-9 immunoassay positivity in either treatment group. Follow-up inter-group comparisons showed better BCH values in GPI/HA, and better NEI VFQ-25 scores in HA 0.2%. Conclusion: Both treatments proved valuable in managing GTOSD, supporting the use of lubricants in this condition. GPI/HA showed a broader pattern of improvement, which should be interpreted cautiously given the observational design and limited inter-group differences.