title: Efficacy of apraclonidine 1% versus pilocarpine 4% for prophylaxis of intraocular pressure spike after argon laser trabeculoplasty.
abstract: OBJECTIVE
  The authors compared the efficacy of apraclonidine 1% versus pilocarpine 4% prophylaxis of post-argon laser trabeculoplasty (ALT) intraocular pressure (IOP) spike.
  
  
  METHODS
  Prospective randomized clinical trial.
  
  
  METHODS
  Two hundred twenty-eight eyes of 228 patients with primary open-angle glaucoma undergoing ALT were studied.
  
  
  METHODS
  Patients were given 1 drop of either apraclonidine 1% (n = 114) or pilocarpine 4% (n = 114) 15 minutes before ALT.
  
  
  METHODS
  Peri-ALT IOPs and incidences of post-ALT IOP spikes at 5 minutes, 1 hour, and 24 hours were compared between the two groups.
  
  
  RESULTS
  The two groups were similar in age, race, and medical dependency. Post-ALT mean IOPs at 5 minutes, 1 hour, and 24 hours were significantly lower than pre-ALT mean IOPs in both apraclonidine (P < 0.001) and pilocarpine (P < 0.001) groups. Incidences of IOP spikes greater than 1, 3, and 5 mmHg at 1 hour post-ALT were 21.1%, 14.9%, and 8.8% for the apraclonidine group and 12.3%, 5.3%, and 4.4% for the pilocarpine group (P = 0.076, 0.015, and 0.18 chi-square test). In the apraclonidine prophylaxis group, patients on long-term apraclonidine showed significantly higher incidence of post-ALT IOP spike than the patients without such long-term apraclonidine use (35.7%, 15 of 42 eyes, vs. 12.5%, 9 of 72 eyes; P = 0.003). In addition, peri-ALT pilocarpine prophylaxis tended to be less effective in patients undergoing long-term pilocarpine therapy but without statistical significance (17.4%, 8 of 46 eyes, vs. 9.4%, 6 of 64 eyes; P = 0.17).
  
  
  CONCLUSIONS
  Peri-ALT pilocarpine 4% was at least as effective as, if not more effective than, apraclonidine 1% in post-ALT IOP spike prophylaxis. Peri-ALT apraclonidine prophylaxis was not effective in patients on long-term apraclonidine, and peri-ALT pilocarpine prophylaxis tended to be less effective in patients undergoing long-term pilocarpine therapy. Pilocarpine 4% can be considered as a first-choice drug for post-ALT IOP spike prophylaxis, especially in patients under treatment with apraclonidine.
authors.affiliation: Kresge Eye Institute, Wayne State University School of Medicine, Detroit, Michigan 48201-1423, USA.
authors.forename: J
authors.initials: J
authors.lastname: Ren
authors.forename: D H
authors.initials: DH
authors.lastname: Shin
authors.forename: H S
authors.initials: HS
authors.lastname: Chung
authors.forename: C M
authors.initials: CM
authors.lastname: Birt
authors.forename: B K
authors.initials: BK
authors.lastname: Glover
authors.forename: M S
authors.initials: MS
authors.lastname: Juzych
authors.forename: B A
authors.initials: BA
authors.lastname: Hughes
authors.forename: C
authors.initials: C
authors.lastname: Kim
mesh_terms: D000368:Aged; D003000:Clonidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005902:Glaucoma, Open-Angle / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007429:Intraocular Pressure / Q000187:drug effects*; D053685:Laser Therapy / Q000009:adverse effects; D008297:Male; D009798:Ocular Hypertension / Q000209:etiology / Q000517:prevention & control*; D009883:Ophthalmic Solutions / Q000008:administration & dosage / Q000627:therapeutic use; D010862:Pilocarpine / Q000008:administration & dosage / Q000627:therapeutic use*; D014130:Trabeculectomy / Q000009:adverse effects*
chemical_list: D009883:Ophthalmic Solutions; D010862:Pilocarpine; C016986:apraclonidine; D003000:Clonidine