Randomised controlled trial comparing the effect of brimonidine and timolol on visual field loss after acute primary angle closure.
OBJECTIVE
To compare the effect of brimonidine and timolol in reducing visual field loss in patients with acute primary angle closure (APAC).


METHODS
In addition to standard acute medical treatment, patients presenting with APAC were randomised to either brimonidine 0.2% or timolol 0.5% upon diagnosis, then twice daily for 4 weeks. After laser peripheral iridotomy (LPI), subjects underwent three baseline perimetry tests during the first week, and then at weeks 4, 8, 12, and 16. Pointwise linear regression analysis was applied to the field series of each of these subjects starting with the third test (total of five tests per subject). Progression was defined as a significant regression slope (p<0.05) showing 1 dB per year or more of sensitivity loss at the same test location in the series. Patients were also compared for prevalence of abnormal fields at 16 weeks, which was defined as an abnormal glaucoma hemifield test result and/or corrected pattern standard deviation outside the 95% confidence limits.


RESULTS
59 subjects (31 in the brimonidine group; 28 in the timolol group) completed the study. There were 47 females (79.7%), the majority of subjects (94.9%) were Chinese and the mean age was 59.2 (SD 7.2) years. There were no significant differences between the two groups with respect to demographic features, presenting intraocular pressure (IOP), duration of symptoms, time from presentation to LPI, or mean IOP at each study visit. Over the 16 week study period, despite adequate statistical power, no difference was found between groups in terms of the number of patients with progressing locations, the mean number of progressing locations per subject, or the mean slope of the progressing locations. Nine (29%) subjects in the brimonidine group and 10 (35.7%) in the timolol group were found to have significant visual field defects at 16 weeks (p = 0.58). 15 out of these 19 subjects (78.9%) already had these visual field defects in the first week.


CONCLUSIONS
In the first 16 weeks after APAC, there was no difference in the prevalence of visual field defects or rate of visual field progression between brimonidine and timolol treated groups.
Aung
T
T
Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, Republic of Singapore. tin11@pacific.net.sg
Oen
F T S
FT
Wong
H-T
HT
Chan
Y-H
YH
Khoo
B-K
BK
Liu
Y-P
YP
Ho
C-L
CL
See
J
J
Thean
L H
LH
Viswanathan
A C
AC
Seah
S K L
SK
Chew
P T K
PT
D000208:Acute Disease; D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D000068438:Brimonidine Tartrate; D018450:Disease Progression; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011810:Quinoxalines / Q000627:therapeutic use*; D013999:Timolol / Q000627:therapeutic use*; D058609:Visual Field Tests; D014794:Visual Fields / Q000187:drug effects*
D000316:Adrenergic alpha-Agonists; D000959:Antihypertensive Agents; D011810:Quinoxalines; D000068438:Brimonidine Tartrate; D013999:Timolol