Increased risk for flap dislocation with perioperative brimonidine use in femtosecond laser in situ keratomileusis.
OBJECTIVE
To determine whether brimonidine 0.2% minimizes the occurrence of subconjunctival hemorrhages without inducing postoperative flap complications in femtosecond laser in situ keratomileusis (LASIK).


METHODS
Centro Oftalmológico Marqués de Sotelo and Hospital NISA Virgen del Consuelo, Valencia, Spain.


METHODS
This prospective contralateral-eye interventional study evaluated consecutive patients who had bilateral simultaneous femtosecond LASIK for myopia (spherical equivalent [SE] range -1.00 to -8.00 diopters) performed with an IntraLase femtosecond laser and a Visx Star 2 excimer laser. One eye of each patient received a single drop of brimonidine tartrate 0.2% (brimonidine group) and the other eye, a single drop of a balanced salt solution (control group).


RESULTS
The study evaluated 136 eyes (68 patients). The difference in the incidence of subconjunctival hemorrhages was statistically significantly lower in the brimonidine group (mean score 2.24 +/- 1.96 [SD]) than in the control group (mean score 7.61 +/- 2.72) (P<.001). However, no eye in the control group and 7 eyes (10.4%) in the brimonidine group had a dislocated flap with folds on the first postoperative day (P = .016). All eyes with dislocated flaps required surgical intervention. At 6 months, there was no significant difference between groups in the percentage of eyes achieving 20/20 or better uncorrected distance visual acuity, in the mean SE, or in the enhancement rate.


CONCLUSIONS
Brimonidine prevented the formation of subconjunctival hemorrhages after femtosecond LASIK but increased the risk for flap dislocation. Thus, surgeons are cautioned against the use of perioperative brimonidine to decrease hemorrhagic complications in femtosecond LASIK.
Muñoz
Gonzalo
G
Refractive Surgery Department, Centro Oftalmológico Marqués de Sotelo and Hospital NISA Virgen del Consuelo, Valencia, Spain. gon.munoz@ono.com
Albarrán-Diego
César
C
Sakla
Hani F
HF
Javaloy
Jaime
J
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000068438:Brimonidine Tartrate; D003229:Conjunctival Diseases / Q000517:prevention & control; D003319:Corneal Stroma / Q000473:pathology; D005130:Eye Hemorrhage / Q000517:prevention & control; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D009216:Myopia / Q000601:surgery; D011183:Postoperative Complications; D011446:Prospective Studies; D011810:Quinoxalines / Q000008:administration & dosage / Q000009:adverse effects*; D012307:Risk Factors; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000139:chemically induced* / Q000473:pathology; D014792:Visual Acuity; D055815:Young Adult
D000316:Adrenergic alpha-Agonists; D011810:Quinoxalines; D000068438:Brimonidine Tartrate