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S.J. Donnelly, D.B. Brooks, H.P. Fechter, III, M. Psolka; Comparison of the Alpha–2 Agonists for Prevention of Intraocular Pressure Elevation after Selective Laser Trabeculoplasty . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5465.
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To compare the efficacy and safety of brimonidine tartrate 0.15% with those of apraclonidine 0.5% in preventing intraocular pressure (IOP) elevations after selective laser trabeculoplasty.
This was an unmasked comparative trial of 20 eyes of 10 patients who underwent selective laser trabeculoplasty for primary open angle glaucoma. The trabecular meshwork in both eyes of each enrolled patient was treated with 360 degrees of laser at the same sitting. One hour prior to treatment, 1 drop of brimonidine 0.15% was randomly placed in the right or left eye and 1 drop of apraclonidine 0.5% was placed in the fellow eye. Intraocular pressure was measured in each eye before applying the study medications to obtain a baseline. In addition, IOP was recorded immediately before the procedure, and at 1 hour and 1 week after laser surgery.
Mean baseline intraocular pressures were 18mmHg on the right and 18.4mmHg on the left. One hour after laser treatment, average change in IOP from baseline was recorded to be –6.6 +/– 3.1mmHg in the brimonidine group and –5.0 +/– 2.8mmHg in the apraclonidine group (P=0.46). One patient (10%) had a 1 hour post–operative increase of 8mmHg in the brimonidine–treated eye and 15mmHg in the apraclonidine–treated eye, both of which were acutely controlled with supplemental topical medication. No other patients in either group had an increase in IOP more than 1mmHg at one hour after treatment. At 1 week, only one patient had an asymmetric increase in intraocular pressure (8mmHg in the brimonidine–treated eye and –0.5mmHg in the apraclonidine–treated eye). Change in baseline IOP at 1 week for the patients overall averaged +0.61mmHg in the brimonidine group and +0.11mmHg in the apraclonidine group (P=0.78). There was no clinically or statistically significant difference in IOP between the groups as measured at 1 hour and 1 week following the procedure. In addition, no non–ocular clinically significant symptoms were noted in either group (such as presyncope).
A single preoperative drop of brimonidine 0.15% had similar efficacy and safety as apraclonidine 0.5% in preventing IOP elevations immediately after selective laser trabeculoplasty in this small pilot study.
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