Effects of topical clonidine versus brimonidine on choroidal blood flow and intraocular pressure during squatting.
OBJECTIVE
Clonidine and brimonidine, two alpha-2 agonists, have been shown to reduce intraocular pressure (IOP) in patients with glaucoma. Little is known, however, about the exact role of alpha receptors in the control of ocular blood flow in the posterior pole of the eye. Hence, the study was conducted to investigate the effects of topical clonidine versus topical brimonidine on choroidal blood flow and intraocular pressure during squatting.


METHODS
This was a randomized, double-masked, controlled, two-way crossover study. Twelve healthy male nonsmoking volunteers, aged between 19 and 35 years were included in the study. Two drops of clonidine or brimonidine were administered in the subjects' study eyes. Continuous measurement using the compact laser Doppler flowmeter was performed during a 6-minute squatting period, to assess choroidal blood flow regulation during an increase in ocular perfusion pressure.


RESULTS
Both substances induced a pronounced but comparable (P = 0.8) decrease in IOP. Squatting increased mean arterial pressure (MAP) and ocular perfusion pressure (P < 0.01). This increase was comparable between the clonidine and the brimonidine study day (P = 0.88). Squatting induced an increase in choroidal blood flow that was less pronounced than the increase in ocular perfusion pressure. Compared with baseline the alpha-2 agonists decreased choroidal blood flow during squatting (P = 0.0026) to a comparable degree (P = 0.86). Vascular resistance increased at baseline and during squatting after administration of the alpha-2 agonists (P < 0.01) in both groups to a comparable degree (P = 0.56).


CONCLUSIONS
Topical alpha-2 agonists may induce changes in choroidal blood flow, even after a single administration. Long-term studies are needed to study potential effects of brimonidine and clonidine in the clinical setting.
Weigert
Günther
G
Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
Resch
Hemma
H
Garhofer
Gerhard
G
Fuchsjäger-Mayrl
Gabriele
G
Schmetterer
Leopold
L
D000287:Administration, Topical; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage*; D000328:Adult; D001783:Blood Flow Velocity / Q000187:drug effects; D000068438:Brimonidine Tartrate; D002829:Choroid / Q000098:blood supply*; D003000:Clonidine / Q000008:administration & dosage*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D017078:Laser-Doppler Flowmetry; D008297:Male; D011187:Posture; D011810:Quinoxalines / Q000008:administration & dosage*; D012039:Regional Blood Flow / Q000187:drug effects; D014065:Tonometry, Ocular
D000316:Adrenergic alpha-Agonists; D011810:Quinoxalines; D000068438:Brimonidine Tartrate; D003000:Clonidine