title: The effect of topical apraclonidine on subconjunctival hemorrhage and flap adherence in LASIK patients.
abstract: OBJECTIVE
  To determine whether the use of topical apraclonidine just before the LASIK procedure prevents subconjunctival hemorrhage and to study its effect on postoperative flap adherence.
  
  
  METHODS
  Topical apraclonidine 0.125% was randomly applied to 1 eye of 66 myopic patients who underwent primary bilateral LASIK. Apraclonidine was instilled 1 hour prior to and 30 seconds before placing the vacuum ring of the microkeratome, whereas the other eye served as control. Thirty minutes after the operation, all patients were examined by the surgeon to evaluate hyperemia and identify flap-related complications (eg, slippage, dislocation, or flap folds). The size of subconjunctival hemorrhage was also evaluated on postoperative days 1 and 7. All 132 eyes in the study were examined after surgery to identify flap folds and/or their dislocation.
  
  
  RESULTS
  In the apraclonidine group, 48 (72.8%) eyes had no hyperemia, 16 (24.2%) eyes had mild hyperemia, 2 (3%) eyes had moderate hyperemia, and no (0%) eyes had severe hyperemia. In the control group, 37 (56.1%) eyes had mild hyperemia, 21 (31.8%) eyes had moderate hyperemia, 1 (1.5%) eye had severe hyperemia, and 7 (10.6%) eyes had no hyperemia. In the apraclonidine group, 44 (66.7%) eyes had no subconjunctival hemorrhage (grade 0); grade 1 was present in 19 (28.8%) eyes whereas grades 2 and 3 were present in 2 (3%) eyes and 1 (1.5%) eye, respectively. In the control group, 19 (28.8%) eyes showed grade 0, 13 (19.7%) eyes had grade 1, and grades 2 and 3 were present in 20 (30.3%) eyes and 14 (21.2%) eyes, respectively. Chi-square test showed a highly significant difference between the two groups (P < .001). No flap-related problems were reported in either group.
  
  
  CONCLUSIONS
  Topical apraclonidine applied before LASIK surgery may prevent immediate postoperative hyperemia and prolonged subconjunctival hemorrhage by its alpha-mimetic vasoconstrictor effect without inducing flap adherence complication.
authors.affiliation: VIC - Vardinoyiannion Eye Institute of Crete, University of Crete, Greece. aslanides@med.uoc.gr
authors.forename: loannis M
authors.initials: lM
authors.lastname: Aslanides
authors.forename: Nikolaos S
authors.initials: NS
authors.lastname: Tsiklis
authors.forename: Efekan
authors.initials: E
authors.lastname: Ozkilic
authors.forename: Efekan
authors.initials: E
authors.lastname: Coskunseven
authors.forename: loannis G
authors.initials: lG
authors.lastname: Pallikaris
authors.forename: Mirko R
authors.initials: MR
authors.lastname: Jankov
mesh_terms: D000293:Adolescent; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage*; D000328:Adult; D003000:Clonidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D003228:Conjunctiva / Q000098:blood supply; D005130:Eye Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000601:surgery; D009883:Ophthalmic Solutions; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000473:pathology*; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D000316:Adrenergic alpha-Agonists; D009883:Ophthalmic Solutions; C016986:apraclonidine; D003000:Clonidine