Brimonidine 0.2% versus apraclonidine 0.5% for prevention of intraocular pressure elevations after anterior segment laser surgery

OBJECTIVE: To compare the efficacy of brimonidine 0.2% with apraclonidine 0.5% in preventing intraocular pressure (IOP) elevations after anterior segment laser surgery. DESIGN: Double-masked, randomized clinical trial. PARTICIPANTS: Sixty-six patients underwent either laser peripheral iridotomy, argon laser trabeculoplasty, or neodymium:yttrium-aluminum-garnet laser capsulotomy. INTERVENTION: Eyes received either one drop of brimonidine 0.2% or apraclonidine 0.5% before laser surgery. MAIN OUTCOME MEASURES: Intraocular pressure, heart rate, and blood pressure were measured before laser surgery and at 1 hour, 3 hours, 24 hours, and 1 week after laser surgery. RESULTS: Before the laser treatment, 33 patients (50.0%) received brimonidine 0.2% and 33 patients (50.0%) received apraclonidine 0.5%. Eight of 33 patients (24.2%) in the brimonidine-treated group and 9 of 33 patients (27.3%) in the apraclonidine group had postoperative IOP increases of 5 mmHg or more. This was not statistically different (P = 0.80). By the time of last follow-up examination, 3 of 33 patients (9.1%) in the brimonidine-treated group and 3 of 33 patients (9.1%) in the apraclonidine group had IOP increases of 10 mmHg or more. This was also not statistically different (P > or = 0.95). The mean IOP reduction from baseline in the brimonidine group (-2.8 +/- 2.8 mmHg) was not statistically different (P = 0.55) compared with the mean IOP reduction in the apraclonidine group (-3.6 +/- 3.3 mmHg). There were no statistically significant changes in mean heart rate or blood pressure in either group except for a slight reduction in diastolic blood pressure at 1 hour (P = 0.005) in the brimonidine group (-5.2 +/- 7.4 mmHg) compared with the apraclonidine group (-0.2 +/- 6.4 mmHg). There were no clinically significant side effects noted in either group. CONCLUSIONS: A single preoperative drop of brimonidine 0.2% is as effective as apraclonidine 0.5% in preventing IOP elevation immediately after anterior segment laser surgery.     

Apraclonidine 0.5% versus brimonidine 0.2% for the control of intraocular pressure elevation following anterior segment laser procedures

BACKGROUND AND OBJECTIVE: Both apraclonidine hydrochloride 0.5% and brimonidine tartrate 0.5% are potent alpha-2 agonists, effective in controlling the intraocular pressure (IOP) rise following argon laser trabeculoplasty (ALT). Brimonidine has recently become available commercially as a 0.2% solution. Our goal in this study was to compare the efficacy and side effect profile of 0.2% brimonidine to that of 0.5% apraclonidine in the prevention of IOP spikes following anterior segment laser procedures. PATIENTS AND METHODS: Patients undergoing argon laser trabeculoplasty, Nd:Yag peripheral iridectomy or posterior capsulotomy were prospectively randomized to receive either apraclonidine 0.5% or brimonidine 0.2%, approximately 10 minutes prior to laser surgery. Intraocular pressure was measured by a masked observer, using Goldmann applanation tonometry, before and 1 hour after the treatment. RESULTS: 51 ALTs, 21 peripheral iridectomies, and 13 posterior capsulotomies were performed. The incidence of an IOP rise greater than 5 mmHg was 3/43 (7.0%) in the brimonidine group and 0/42 (0%) in the apraclonidine group (P = 0.08, chi-squared). There were no IOP elevations greater than 8 mmHg. All IOP rises of greater than 5 mmHg occurred in the ALT sub-group, and within this sub-group, the mean change in IOP from pre- to post-op was -4.00 +/- 5.87 in the brimonidine group versus -4.29 +/- 3.86 in the apraclonidine group (P = 0.84). There was a statistically significant decrease in IOP from baseline in both drug groups (P < .0001). CONCLUSIONS: Both drugs are highly effective in controlling IOP spikes following anterior segment laser procedures. There is a tendency toward higher risk of IOP rise following argon laser trabeculoplasty with 0.2% brimonidine as compared to 0.5% apraclonidine, however, this was not statistically significant.     

Brinzolamide 1% versus apraclonidine 0.5% to prevent intraocular pressure elevation after neodymium:YAG laser posterior capsulotomy

PURPOSE: To compare the efficacy of brinzolamide 1% with that of apraclonidine 0.5% in preventing intraocular pressure (IOP) rise after neodymium:YAG (Nd:YAG) laser posterior capsulotomy. SETTING: Department of Ophthalmology, Akdeniz University, Antalya, Turkey. METHODS: One hundred fifteen patients who had Nd:YAG laser posterior capsulotomy for posterior capsule opacification were prospectively randomized to receive brinzolamide 1% (57 patients) or apraclonidine 0.5% (58 patients) approximately 1 hour before laser surgery. A masked observer measured IOP by Goldmann applanation tonometry before treatment and after treatment at 1, 2, and 3 hours and 7 days. RESULTS: The mean IOP changes from baseline were not statistically different between the study groups at 1, 2, and 3 hours and 7 days (P =.109, P = .764, P =.275, and P =.879, respectively). The incidence of IOP elevation of 5 mm Hg or higher was 12.2% (7 of 57 eyes) in the brinzolamide group and 10.3% (6 of 58 eyes) in the apraclonidine group (P = .743); IOP elevations of 10 mm Hg and greater occurred in 3.5% (2 of 57 eyes) and 1.7% (1 of 58 eyes) (P = .618), respectively. There were no IOP elevations greater than 20 mm Hg in either group. CONCLUSION: Brinzolamide 1% and apraclonidine 0.5% given prophylactically before Nd:YAG laser capsulotomy were effective in preventing IOP spikes after treatment.     

Control of intraocular pressure elevations after argon laser trabeculoplasty: comparison of brimonidine 0.2% to apraclonidine 1.0%.

OBJECTIVE: To determine whether brimonidine 0.2% can control intraocular pressure (IOP) spikes as well as apraclonidine 1.0% can in those patients undergoing argon laser trabeculoplasty (ALT). DESIGN: Prospective, randomized, double-masked, clinical trial. PARTICIPANTS: A total of 56 eyes of 41 patients with open-angle glaucoma or ocular hypertension were entered in the study; 46 eyes of 41 patients were eventually used for the final analysis. INTERVENTION: Patients were randomized to receive either brimonidine 0.2% or apraclonidine 1.0% before and after 360 degrees ALT. Both patient and physician were masked as to which agent each patient received. MAIN OUTCOME MEASURES: Intraocular pressure measurements were recorded before surgery and at 1, 2, and 4 hours after surgery. The difference between the preoperative IOP (baseline) and the highest recorded postoperative IOP was recorded as the maximum IOP change. The mean of the maximum IOP change for each group was analyzed using a two-sample, one-tailed t test. RESULTS: The mean of the maximum IOP change in the brimonidine 0.2% group was -2.6+/-3.6 mmHg, and the mean for the apraclonidine 1.0% group was -2.3+/-3.7 mmHg (P = 0.8). No patient had a pressure spike greater than 10 mmHg. CONCLUSIONS: Brimonidine 0.2% appears to be as effective as apraclonidine 1.0% in preventing IOP spikes after argon laser trabeculoplasty.     

Effectiveness of apraclonidine 1% in preventing intraocular pressure rise following macular hole surgery

AIM: To determine the efficacy of apraclonidine hydrochloride 1% in preventing intraocular pressure (IOP) spikes following idiopathic macular hole (IMH) surgery with platelet adjunct and intraocular gas tamponade. METHODS: This is a prospective, double masked, randomised study to compare apraclonidine hydrochloride 1%, an alpha(2) agonist, with a placebo in the prevention of IOP rises following macular hole surgery. Each patient was randomly selected to receive either the study drug or the placebo; one drop was instilled in the conjunctival sac 2 hours preoperatively and on completion of the procedure. IOP was measured at baseline and at 1, 3, 6, 24, 48 hours, and 2 weeks postoperatively. Blood pressure and heart rate were also recorded at baseline and at 3 and 24 hours postoperatively. Macular hole repair surgery was performed as standardised in the unit with a vitrectomy, platelet concentrate, and complete fill of the vitreous cavity with perfluoropropane gas (C(3)F(8)) at a concentration of 16%. RESULTS: 25 patients (26 eyes) were enrolled. 12 eyes received apraclonidine hydrochloride 1% (mean age 70.7; range 62-78 years) and 14 eyes received the placebo (mean age 70.0; range 57-81 years). At baseline evaluation the mean IOP was 15.6 mm Hg for the study group and 14.3 mm Hg for the placebo group. The mean postoperative IOP at 1 hour, 3 hours, 6 hours, and 24 hours was 10.6, 9.6, 8.2, and 14.0 mm Hg in the apraclonidine group. In the control group at the same time intervals the mean IOP was 23.4, 17.5, 19.2, and 24.7 mm Hg. These readings were statistically significant different: 1 hour (p=0.0001); 3 hours (p=0.0015); 6 hours (p<0.0001); and 24 hours (p=0.019), the readings at 48 hours and 2 weeks were not statistically significant different (p=0.15 and p=0.59). Only one of the patients in the study group had an IOP above 25 mm Hg at any time. In the control group an IOP above 25 mm Hg was found in seven patients (50%) at the 1 hour postoperative measurement. At 2 weeks the IOP was recorded below 25 mm Hg in all patients. No statistically significantly difference was noted between the two groups regarding the systolic or diastolic blood pressure values and the heart rate records. No local or systemic adverse reactions were observed. CONCLUSIONS: Apraclonidine hydrochloride 1% appears to be an efficacious and safe drug in the prophylaxis of early postoperative IOP elevations in patients undergoing macular hole surgery.     

Effect of 0.2% brimonidine in preventing intraocular pressure elevation after Nd:YAG laser posterior capsulotomy

BACKGROUND AND OBJECTIVE: To determine the prophylactic effect of 0.2% brimonidine in reducing the elevated intraocular pressure (IOP) in patients undergoing Nd:YAG laser posterior capsulotomy. PATIENTS AND METHODS: The 81 patients (81 eyes), who underwent Nd:YAG laser posterior capsulotomy, were allocated to two treatment groups. One drop of 0.2% brimonidine or vehicle was instilled 1 hour preoperatively and one drop immediately after capsulotomy. IOPs were measured preoperatively and 1, 2, 3, and 24 hours postoperatively. RESULTS: Intraocular pressure decreased from the baseline in the brimonidine group by the third postoperative hour (P<0.05), while the vehicle group exhibited an increase. Intraocular pressure elevations of 5 mm Hg or greater occurred in 7.3% (3/41) in the brimonidine group compared to 20.0% (8/40) in the vehicle group. IOP elevations of 10 mm Hg or greater occurred in 2.4% (1/41) in the brimonidine group compared to 7.5% (3/40) in the vehicle group. CONCLUSIONS: One drop of 0.2% brimonidine instilled 1 hour preoperatively and immediately after capsulotomy was found to be efficacious and safe in preventing IOP elevations that frequently follow Nd:YAG laser posterior capsulotomy.     

Effect of topical brinzolamide 1% and brimonidine 0.2% on intraocular pressure after phacoemulsification

PURPOSE: To compare the effectiveness of brinzolamide 1% (Azopt) and brimonidine 0.2% (Alphagan) with a placebo in preventing an early increase in intraocular pressure (IOP) after phacoemulsification. SETTING: Department of Ophthalmology, Baskent University, School of Medicine, Ankara, Turkey. METHODS: In this prospective double-masked study, 90 eyes of 90 patients having clear corneal phacoemulsification were randomly divided into 3 groups of 30 eyes each. One hour before surgery, 1 group received 1 drop of brinzolamide 1%, another received 1 drop of brimonidine 0.2%, and the third received 1 drop of a balanced saline solution (placebo). The IOP was measured preoperatively and 3 and 16 to 20 hours postoperatively. RESULTS: Three hours postoperatively, the mean IOP increased by 4.2 mm Hg +/- 7.0 (SD), 3.2 +/- 6.4 mm Hg, and 5.3 +/- 4.2 mm Hg in the brinzolamide, brimonidine, and placebo groups, respectively. The IOP increase from baseline was significant in all 3 groups (all P<.01), with no difference between the groups (P>.05). The change in IOP at 16 to 20 hours was 0.2 +/- 2.8 mm Hg, 0.2 +/- 2.4 mm Hg, and -0.8 +/- 2.4 mm Hg, respectively. The changes were not significant compared to baseline (all P>.05). Six eyes (20%) in the brinzolamide group, 5 eyes (16.7%) in the brimonidine group, and 7 eyes (23.3%) in the placebo group had an IOP higher than 25 mm Hg 3 hours postoperatively; the difference between groups was not significant (P =.8). CONCLUSION: Prophylactic use of 1 drop of brinzolamide or brimonidine was not more effective than a placebo in controlling early postoperative IOP elevations after clear corneal phacoemulsification.     

Efficacy of brimonidine 0.2% in controlling acute postoperative intraocular pressure elevation after phacoemulsification

PURPOSE: To determine the efficacy of brimonidine tartrate 0.2% drops given 2 times a day in reducing intraocular pressure (IOP) spikes during the first 24 hours after phacoemulsification cataract surgery. SETTING: Department of Ophthalmology, General Hospital of Patras Agios Andreas, Patras, Greece. METHODS: In this prospective double-blind placebo-controlled study, 1 eye of 40 consecutive normotensive cataract patients having small-incision cataract surgery was randomized into 1 of 2 treatment arms. Twenty patients received a placebo (artificial tears) and 20 patients received brimonidine tartrate 0.2% drops 2 times a day the day before and the day of surgery. Diurnal IOP variation was the primary efficacy variable; IOP was measured at baseline, before surgery, and 4, 6, 12, and 24 hours postoperatively. RESULTS: The placebo group had higher IOPs at every time point after surgery. Peak elevation of IOP occurred 6 hours after surgery. The mean IOP in the placebo group (27.71 mm Hg +/- 3.75 [SD]) was statistically significantly higher than in the brimonidine group (21.45 +/- 1.32 mm Hg) (P<.001). A major IOP rise (>/=20 mm Hg above baseline IOP) occurred in 1 patient (5%) in the placebo group who required emergency hypotensive therapy. Twenty-four hours after surgery, 11 eyes (55%) in the brimonidine group and 4 eyes (20%) in the placebo group had an IOP lower than baseline. CONCLUSION: Prophylactic treatment with brimonidine tartrate 0.2% 2 times a day for 2 days was effective in reducing IOP peaks throughout the first 24 hours after phacoemulsification surgery.     

Brimonidine 0.2% versus brimonidine Purite 0.15%: prophylactic effect on iop elevation after Nd:YAG laser posterior capsulotomy.

AIMS: The aim of this study was to compare the prophylactic effect of brimonidine 0.2% versus brimonidine Purite 0.15% on intraocular pressure (IOP) increase after Nd:YAG laser posterior capsulotomy. METHODS: In this prospective, double-masked, randomized, controlled study, 106 patients (106 eyes) who underwent Nd:YAG laser posterior capsulotomy were allocated to a brimonidine 0.2% group (35 eyes), a brimonidine Purite 0.15% group (36 eyes), or a vehicle group (35 eyes). One (1) drop of brimonidine 0.2%, brimonidine Purite 0.15%, or vehicle was instilled 1 h preoperatively and 1 drop immediately after Nd:YAG laser posterior capsulotomy. IOPs were measured preoperatively and at 1, 2, 3, and 24 h postoperatively. RESULTS: Decreases in IOP from baseline ranged from 2.3 to 2.7 mmHg in the brimonidine 0.2% group and 2.2-2.5 mmHg in the brimonidine Purite 0.15% group (P < 0.05), whereas the vehicle group exhibited a rise in IOP. IOP elevations of less than 5 mmHg occurred in 22.9% of patients in the brimonidine 0.2% group, 27.8% in the brimonidine Purite 0.15% group, and 48.6% in the vehicle group. Spikes of IOP greater than 10 mmHg occurred in 2.9% of patients in the brimonidine 0.2% group, 2.8% in the brimonidine Purite 0.15% group, and 8.6% in the vehicle group. The incidence of IOP elevation was not statistically significant between the brimonidine 0.2% and the brimonidine Purite 0.15% groups (P < 0.05). CONCLUSIONS: Brimonidine 0.2% and brimonidine Purite 0.15% have similar efficacy in the prevention of IOP elevation after Nd:YAG laser posterior capsulotomy.     

阿拉可乐定与布林唑胺-噻吗洛尔滴眼液预防激光晶状体囊切开术后眼压升高的对照研究

目的：：比较1％布林唑胺和0.5％噻吗洛尔联合制剂(FCBT)与0.5％阿拉可乐定( APRA)滴眼液预防接受Nd：YAG激光晶状体囊切开术患者术后眼压升高的疗效。方法：前瞻随机对照临床研究。研究包括90例(90眼)接受Nd：YAG激光晶状体囊切开术治疗后囊膜混浊( PCO )患者。患者术前1 h随机给予APRA ( n=45)或FCBT ( n=45)治疗。一名设盲检查者使用Goldmann压平眼压计检查术前及术后1,2,3,24 h和7 d的眼压。眼压检查结果分为以下两类：术后眼压升高5~<10 mm Hg和眼压升高≥10 mm Hg。眼压升高<5 mm Hg认为没有临床上的显著改变。结果：APRA组和 FCBT 组术前当天的平均眼压分别为14.1±2.1 mm Hg和13.2±2.1 mm Hg,差异无统计学意义(P=0.066)。随访期间,FCBT组的平均眼压较低但差异无统计学意义。 APRA组中的6名患者(13.3％)和FCBT组中的4名患者(8.9％)术后至少有一次眼压升高5~<10 mm Hg,差异无统计学意义( P=0.243)。眼压升高≥10 mm Hg 在 APRA 组与 FCBT 组中分别出现3眼(6.7％)和1眼(2.2％),差异无统计学意义(P=0.542)。结论：APRA和FCBT均可有效预防眼压升高且APRA足以应对常规病例。对于需要加强降低眼压的患者-如预先存在青光眼的患者(其术后眼压升高的风险更大)可选择FCBT。     

A 3-month comparison of efficacy and safety of brimonidine-purite 0.15% and brimonidine 0.2% in patients with glaucoma or ocular hypertension.

PURPOSE: To compare the efficacy and safety of brimonidine Purite 0.15% (ALPHAGAN P) BID with brimonidine 0.2% (ALPHAGAN) BID in patients with glaucoma or ocular hypertension. METHODS: 3-month, multicenter, randomized, double-masked trial. Eligible patients were taking brimonidine 0.2% BID for at least 6 weeks prior to study entry and their intraocular pressure (IOP) was < or = 21 mm Hg. Patients were randomly assigned to receive either brimonidine Purite 0.15% BID (n = 203) or brimonidine 0.2% BID (n = 204). Scheduled visits were prestudy, baseline, and weeks 2, 6 and 12. IOP was measured at hour 0 and hour 2 to evaluate efficacy. Safety was measured by monitoring adverse events. Patient satisfaction and comfort were also evaluated at all visits. RESULTS: There was no statistically significant difference between the brimonidine 0.2% and brimonidine Purite 0.15% groups with respect to mean IOP at baseline. The IOP-lowering efficacy of brimonidine Purite 0.15% was equivalent to that of brimonidine 0.2% and both study treatments maintained IOP-lowering effects of brimonidine 0.2%. There were no significant between-group differences in mean IOP. The differences in the mean IOPs were < or = 0.26 mm Hg and the mean change from baseline IOP was < or = 0.35 mm Hg at all follow-up time points. There were no statistically significant differences between the two groups in the overall incidence of adverse events. The most commonly reported treatment-related adverse events were conjunctival hyperemia and allergic conjunctivitis: both were mild in severity. CONCLUSION: Brimonidine Purite 0.15% dosed BID provides equal IOP-lowering efficacy to brimonidine 0.2% BID. Patients previously controlled on brimonidine 0.2% can be successfully switched to brimonidine Purite 0.15%.     

A comparison of the short-term hypotensive effects and side effects of unilateral brimonidine and apraclonidine in patients with elevated intraocular pressure

PURPOSE: To compare the short-term ocular hypotensive efficacy and side effects of 0.2% brimonidine and 0.5% apraclonidine in patients with elevated intraocular pressure (IOP). METHODS: We performed a double-masked, placebo-controlled study to compare the efficacy of the application of 0.2% brimonidine and 0.5% apraclonidine for the effect of IOP, systemic blood pressure and heart rate in 20 newly diagnosed ocular hypertensive patients. Effects on the untreated fellow eye and ocular side effects were also determined. All measurements were performed 1, 2, 4, 6 and 8 h after the instillation of one drop. RESULTS: Brimonidine and apraclonidine significantly reduced IOP from baseline at all observation times. No significant difference was observed between the treatment groups. IOP decreased significantly in the untreated fellow eye in the brimonidine group at 4-, 6- and 8-hour checks and at 6-hour checks in the apraclonidine group when compared with placebo. Blood pressure and heart rate decreased significantly in the brimonidine group compared with placebo. Apraclonidine did not affect blood pressure or heart rate any differently than placebo. The pupil diameter and the interpalpebral fissure width significantly increased in the apraclonidine group, but not in the brimonidine group. There were no significant differences in the overall incidence of foreign body sensation, burning and stinging and dry mouth in the treatment groups. CONCLUSIONS: In the short-term, brimonidine was effective in reducing IOP in patients with elevated IOP and was equivalent in efficacy to apraclonidine. On the other hand, a significant change in blood pressure and heart rate was observed with brimonidine; there was no change at all in the apraclonidine group.     

Effect of topical brimonidine on intraocular pressure after small incision cataract surgery

PURPOSE: To evaluate the effect of brimonidine 0.2% on intraocular pressure (IOP) after small incision cataract surgery. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This prospective randomized study comprised 80 eyes of 40 patients scheduled for small incision cataract surgery in both eyes. In each patient, 1 eye was randomly assigned to receive 1 drop of brimonidine 0.2% or no treatment (control) immediately after surgery. The fellow eye received the other assigned treatment. All patients had standardized surgery by the same surgeon with sodium hyaluronate 1%, a temporal 3.5 mm sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable intraocular lens. The IOP was measured preoperatively as well as 6 and 20 to 24 hours and 1 week postoperatively. RESULTS: Six hours after surgery, the mean increase in IOP was 4.7 mm Hg +/- 6.1 (SD) in the brimonidine group and 4.6 +/- 5.3 mm Hg in the control group. In each group, 17 eyes (43%) had an IOP increase of 5 mm Hg or more. Twenty to 24 hours after surgery, the mean increase in IOP was 1.5 +/- 4.2 mm Hg in the brimonidine group and 1.6 +/- 4.4 mm Hg in the control group. There were no statistically significant between-group differences at any measurement. CONCLUSIONS: In both groups, IOP significantly increased 6 hours and 20 to 24 hours after small incision cataract surgery. Brimonidine 0.2% failed to reduce the IOP increase observed after small incision cataract surgery.     

Unoprostone as adjunctive therapy to timolol: a double masked randomised study versus brimonidine and dorzolamide

AIMS: To compare the safety and efficacy of unoprostone, brimonidine, and dorzolamide as adjunctive therapy to timolol in patients with primary open angle glaucoma or ocular hypertension. METHODS: This was a randomised, double masked, parallel group, multicentre (14) study. After using timolol maleate 0.5% monotherapy twice a day for 2 weeks, patients (n = 146) with an early morning intraocular pressure (IOP) between 22 and 28 mm Hg, inclusively, received unoprostone isopropyl 0.15% (n = 50), brimonidine tartrate 0.2% (n = 48), or dorzolamide hydrochloride 2.0% (n = 48) twice daily as adjunctive therapy to timolol maleate 0.5% for another 12 weeks. Safety was based on comprehensive ophthalmic examinations, adverse events, and vital signs. Efficacy was based on mean change from baseline in the 8 hour diurnal IOP at week 12. Baseline was defined as values obtained after 2 weeks of timolol monotherapy. RESULTS: Each drug was safe and well tolerated. Burning/stinging was the most common treatment emergent adverse event. No clinically relevant changes from baseline were observed for any ophthalmic examination or vital signs. At week 12, each adjunctive therapy produced statistically significant (p<0.001) reductions from timolol treated baseline in the mean 8 hour diurnal IOP (-2.7 mm Hg, unoprostone; -2.8 mm Hg, brimonidine; -3.1 mm Hg, dorzolamide). The extent of IOP reduction did not differ significantly between unoprostone and either brimonidine (p = 0.154) or dorzolamide (p = 0.101). CONCLUSION: Unoprostone was safe and well tolerated and provided a clinically and statistically significant additional reduction in IOP when added to stable monotherapy with timolol. Furthermore, unoprostone was not significantly different from brimonidine and dorzolamide as adjunctive therapy to timolol.     

Effects of central corneal thickness on the efficacy of topical ocular hypotensive medications

PURPOSE: To determine the effect of central corneal thickness (CCT) on the efficacy of intraocular pressure (IOP)-reducing drugs in patients with ocular hypertension (OHT). METHODS: This retrospective study analyzed research records of 115 OHT patients and 97 ocular normotensive (ONT) volunteers. CCT was measured by slit-lamp pachymetry and IOP by pneumatonometry. The OHT patients were divided into Thick (>540 microm, n=52) and Thin (相似文献   

Reversal of intraocular pressure increases with 0.5% apraclonidine after dilated fundus examination in patients with chronic open-angle glaucoma.

BACKGROUND: Apraclonidine 1.0% has been shown to reverse the potential intraocular pressure (IOP) increase after pupil dilation IOP increases in patients with chronic open-angle glaucoma. However, it is only approved for preventing IOP spikes after laser surgery. The purpose of this study is to determine the effectiveness of 0.5% apraclonidine in reversing IOP increases after pupillary dilation in patients with chronic open-angle glaucoma. METHODS: Twenty-two patients with chronic open-angle glaucoma were found to have an increase in post-dilation IOP of at least 4 mmHg from pre-dilated levels (baseline) in both eyes. IOP was measured 1 hour after dilation, after which two drops of 0.5% apraclonidine were instilled in one eye and the IOP was remeasured 15 minutes later in both eyes. Instillation of 0.5% apraclonidine in one eye was continued every 15 minutes and IOP was measured 15 minutes after each instillation, until the pressure returned to baseline levels. RESULTS: The IOP of the initially treated eye of all 22 patients returned to within levels clinically insignificant from baseline IOP within 90 minutes. By comparison, the IOP of the control group (untreated eye) remained elevated. Once the initial treatment eye returned to baseline levels, the control group was then treated with 0.5% apraclonidine, resulting in a lowering effect of the IOP in similar fashion to the initial treated group. CONCLUSIONS: Apraclonidine 0.5% appears to be effective in reduction of post-dilated IOP increases in patients with chronic open-angle glaucoma.     

Long-term brimonidine therapy in glaucoma patients with apraclonidine allergy

PURPOSE: To report the use of brimonidine in patients with a documented ocular allergy to apraclonidine. METHODS: We conducted a prospective, open-label study on the use of long-term brimonidine therapy in 57 patients with chronic glaucoma with documented allergy to apraclonidine. The study patients were placed on brimonidine tartrate 0.2%, 1 drop three times daily in one or both eyes, either as additive therapy to a medical regimen devoid of apraclonidine for further lowering of intraocular pressure (25 patients) or as a replacement for apraclonidine at the time of diagnosis of apraclonidine ocular allergy for maintenance of intraocular pressure control (32 patients). Clinical symptoms and signs of ocular allergy to brimonidine were monitored for up to 18 months. RESULTS: During the treatment period of up to 18 months, six (10.5%) of 57 patients developed slit-lamp biomicroscopic findings and subjective symptoms of an ocular allergic reaction that led to discontinuation of brimonidine treatment. All six patients developed ocular allergy to topical brimonidine 0.2% during the first 4 months of therapy. The addition of brimonidine 0.2% topical medication or the replacement of apraclonidine with brimonidine resulted in a significant decrease in mean intraocular pressure from 20.5+/-5.3 to 16.5+/-4.2 mm Hg (P < .0001) at the mean treatment period of 10.6+/-4.6 months (range, 0.5 to 18.0 months in all 57 patients: 5 to 18 months in the 51 patients without brimonidine allergy and 0.5 to 3.8 months in the six patients who developed brimonidine allergy. CONCLUSIONS: The incidence of ocular allergy after the use of brimonidine 0.2% topical medication for up to 18 months was 10.5% in patients with a documented history of apraclonidine allergy. Therefore, it is generally safe as well as efficacious to administer brimonidine to patients with an ocular allergy to apraclonidine.     

Comparing Brimonidine 0.2% to Apraclonidine 1.0% in the Prevention of Intraocular Pressure Elevation and Their Pupillary Effects Following Laser Peripheral Iridotomy

Purpose To compare the effects of brimonidine 0.2% and apraclonidine 1% on intraocular pressure (IOP) and pupil size in patients undergoing laser peripheral iridotomy (LPI).Methods Forty patients (40 eyes) with occludable angle or angle-closure glaucoma requiring LPI were recruited. Patients were randomized to receive either brimonidine 0.2% or apraclonidine 1% before and after LPI. The IOPs were measured at 1, 2 and 3h after LPI, and pupil size was measured before and at 45min after eyedrop instillation. Both parameters were analyzed using the t test.Results There were 20 patients in each group. The baseline IOP was 17.1 ± 3.2mmHg for the brimonidine group and 16.7 ± 2.8mmHg for the apraclonidine group (P = 0.67) (t test). The mean IOP 3h after laser treatment was 18.2 ± 7.8mmHg for the brimonidine group and 15.7 ± 5.6mmHg for the apraclonidine group (P = 0.25) (t test). There was no statistically significant difference between the two groups in the mean IOP changes at 1, 2, or 3h after LPI. The mean change in pupil size after brimonidine was –0.33 ± 0.37mm and after apraclonidine was +0.90 ± 0.87mm. The difference was significant (P < 0.001).Conclusion Brimonidine 0.2% was found to have an efficacy comparable to that of apraclonidine 1.0% in preventing post LPI IOP spikes. Apraclonidine 1.0% tends to have a pupil dilating effect while brimonidine 0.2% tends to constrict the pupil. Jpn J Ophthalmol 2005;49:89–92 © Japanese Ophthalmological Society 2005     

A comparison of the fixed combination of latanoprost and timolol with the unfixed combination of brimonidine and timolol in patients with elevated intraocular pressure. A six month, evaluator masked, multicentre study in Europe

PURPOSE: To compare the intraocular pressure (IOP) reducing effect and safety of fixed combination (FC) latanoprost/timolol with unfixed combination (UFC) brimonidine/timolol in patients with increased IOP. METHODS: In this 6 month, randomised, evaluator masked, parallel group European study, patients with glaucoma or ocular hypertension and IOP > or =21 mm Hg on monotherapy or >16 mm Hg on dual therapy received either FC latanoprost/timolol at 8:00AM or UFC brimonidine/timolol at 8:00AM and 8:00PM. The primary outcome was the difference from baseline to month 6 in mean diurnal IOP reduction. RESULTS: 325 of 334 randomised patients were included in intent to treat analyses (FC latanoprost/timolol, 163; UFC brimonidine/timolol, 162). Baseline diurnal IOP levels were similar: FC latanoprost/timolol, 26.4 (SD 2.7) mm Hg; UFC brimonidine/timolol, 26.5 (SD 2.8) mm Hg (p = 0.851). At month 6, levels were 16.9 (SD 2.8) mm Hg in FC latanoprost/timolol patients and 18.2 (SD 3.1) mm Hg in UFC brimonidine/timolol patients (p<0.001). No adverse events were reported by 76.4% and 75.5% of patients receiving FC latanoprost/timolol versus UFC brimonidine/timolol, respectively. Larger proportions of brimonidine/timolol treated patients reported study medication related adverse events (18.6% v 7.3%) and discontinued study participation because of this (10.8% v 1.8%). CONCLUSION: Fixed combination latanoprost/timolol administered once daily is both more effective and better tolerated than twice daily dosing with UFC brimonidine/timolol.     

Preventing intraocular pressure increase after phacoemulsification and the role of perioperative apraclonidine

PURPOSE: To evaluate the effectiveness of prophylactic topical apraclonidine 1% in preventing an intraocular pressure (IOP) rise in the early period after uneventful phacoemulsification with intraocular lens (IOL) implantation. SETTING: District general hospital, United Kingdom. METHODS: In this prospective masked randomized trial, 61 patients had elective, routine, corneal tunnel, sutureless phacoemulsification with in-the-bag foldable IOL implantation. A single surgeon operated on all the patients. Patients were randomized to receive topical apraclonidine 1% eyedrops (n = 31) or artificial tears (control group, n = 30) 1 hour preoperatively and at the end of the surgery. An observer masked to the perioperative drops used measured the IOP preoperatively and 3 to 6 hours and 16 to 24 hours postoperatively. The primary outcome was the change in IOP between the baseline and the 2 postoperative intervals. The IOP changes within and between the groups were analyzed using the t test and chi-square test. RESULTS: The changes between the postoperative and preoperative IOPs in the study groups were statistically significant (apraclonidine, P = 0.018 and P = 0.007, respectively; artificial tears, P = 0.028 and P = 0.023, respectively; paired t test). There was no significant difference in the postoperative IOP between the apraclonidine and control groups 3 to 6 hours and 16 to 24 hours postoperatively (P = 0.717 and P = 0.497, respectively; independent t test). The mean difference was 0.2 mm Hg (95% confidence interval [CI], -3.4 to 3.1) in the apraclonidine group and 2.2 mm Hg (95% CI, -2.5 to 7.0) in the control group. In each group, a few patients had an IOP greater than 30 mm Hg in the first 24 hours. CONCLUSION: Prophylactic topical perioperative apraclonidine 1% did not cause a significant reduction in the postoperative IOP when compared with a control group.