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.


METHODS
Double-masked, randomized clinical trial.


METHODS
Sixty-six patients underwent either laser peripheral iridotomy, argon laser trabeculoplasty, or neodymium:yttrium-aluminum-garnet laser capsulotomy.


METHODS
Eyes received either one drop of brimonidine 0.2% or apraclonidine 0.5% before laser surgery.


METHODS
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.
Chen
T C
TC
Glaucoma Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA. teresa_chen@meei.harvard.edu
Ang
R T
RT
Grosskreutz
C L
CL
Pasquale
L R
LR
Fan
J T
JT
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage*; D000368:Aged; D000869:Anterior Eye Segment / Q000601:surgery*; D001794:Blood Pressure; D000068438:Brimonidine Tartrate; D003000:Clonidine / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D004311:Double-Blind Method; D005260:Female; D005902:Glaucoma, Open-Angle / Q000601:surgery; D006339:Heart Rate; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D007498:Iris / Q000601:surgery; D053685:Laser Therapy; D008297:Male; D009798:Ocular Hypertension / Q000517:prevention & control*; D009883:Ophthalmic Solutions; D011183:Postoperative Complications / Q000517:prevention & control*; D011810:Quinoxalines / Q000008:administration & dosage*; D012449:Safety; D014130:Trabeculectomy
D000316:Adrenergic alpha-Agonists; D009883:Ophthalmic Solutions; D011810:Quinoxalines; D000068438:Brimonidine Tartrate; C016986:apraclonidine; D003000:Clonidine