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P.T. Chew, F.T. Oen, H. Wong, Y. Chan, B. Khoo, Y. Liu, C. Ho, A.C. Viswanathan, S.K. Seah, T. Aung; Randomized Controlled Trial Comparing the Effect of Brimonidine and Timolol on Visual Field Loss After Acute Primary Angle Closure . Invest. Ophthalmol. Vis. Sci. 2003;44(13):121.
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Purpose: 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 3 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 baseline test (total of 5 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. Results: Fifty-nine 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 ± 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. 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). All but 2 subjects (one from each group) already had these visual field defects at baseline. Over the 16-week study period, no difference was found in the number of patients with progressing locations, the mean number of progressing locations per subject, or the mean slope of the progressing locations. Conclusions: In the first 16 weeks after APAC, patients treated with timolol and brimonidine have comparable prevalence of visual field defects and visual field progression. Visual field tests performed in the first week after APAC is predictive of outcome at 16 weeks.
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