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Y Liu, T Aung, FT S Oen, B-K Khoo, Y-H Chan, C-L Ho, LH Thean, SK L Seah, PT K Chew; Randomised Trial Comparing Brimonidine and Timolol in the Initial Management of Acute Angle Closure . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3421.
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Purpose: To compare the effect of brimonidine and timolol in the initial management of acute angle closure (AAC). Methods: One hundred and seven patients with AAC at 3 Singapore hospitals were recruited into the study. In addition to receiving systemic acetazolamide, topical pilocarpine and steroids, patients were randomised to treatment with either brimonidine 0.2% or timolol 0.5% at presentation and twice daily thereafter. The main outcome measures were the resolution of the acute attack and the need for filtering surgery due to failed medical treatment. Patients were further analyzed for factors that may have contributed to failure of resolution of the acute episode using logistic regression, taking into account demographic factors, past medical history and factors related to the acute glaucoma episode. Results: Of the 107 subjects, there were 83 females (77.6%), and the majority of subjects (95%) were Chinese. The mean age was 61.6 9.1 years (range 42.6 to 83.6). 48 subjects were randomised to brimonidine treatment and 59 to timolol. The mean duration of acute symptoms was 2.3 + 2.7 days in the brimonidine-treated group and 2.5 + 2.7 days in the timolol-treated group. There was failure of resolution of the acute attack in 3/48 subjects (6.3%, 95% CI 1.3% to 17.2%) in the brimonidine-treated group, as compared to 10/59 subjects (17%, 95% CI 8.4% to 29%) in the timolol-treated group (p = 0.09, OR = 3.1 [95% CI 0.79 to 11.8]). Adjusting for age, sex, duration of symptoms and history of ischemic risk factors (diabetes, hypertension or ischemic heart disease), the odds ratio increased to 4.0 (95% CI 0.94 to 16.7, p = 0.06). Filtering surgery due to failed medical treatment was required for 3/48 subjects and 5/59 subjects (8.5%, 95% CI 2.8% to 18.7%) respectively (p=0.73). Conclusion: In the initial management of acute angle closure, patients treated with timolol seem to have a higher risk of failure of resolution of the acute attack as compared to those treated with brimonidine, although the rates of filtering surgery required due to failed medical treatment were comparable in the 2 groups.
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