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G. L. Spaeth, J. Caprioli, P. Bernstein, R. Schiffman; Control of Intraocular Pressure and Intraocular Pressure Fluctuation With Fixed Combination Brimonidine-Timolol versus Brimonidine or Timolol Monotherapy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):171.
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Recent evidence suggests that reducing both intraocular pressure (IOP) and its fluctuation may be important for preventing visual field loss in glaucoma. Control of long-term IOP fluctuation may be particularly important in patients with well-controlled IOP. The purpose of the current analysis was to evaluate control of IOP fluctuation and mean IOP in glaucoma and ocular hypertension patients treated with fixed-combination brimonidine-timolol compared with brimonidine or timolol alone.
This was a post-hoc analysis of data from 2 identical, 12-month, randomized, double-masked, multicenter trials. Patients were treated with fixed-combination brimonidine-timolol BID (n = 385), brimonidine tartrate 0.2% TID (n = 382), or timolol 0.5% BID (n = 392). IOP was measured at 8 AM, 10 AM, 3 PM, and 5 PM (baseline, weeks 2 and 6, and months 3, 6, 12) or at 8 AM and 10 AM (month 9). IOP fluctuation was defined as the standard deviation of IOP measurements.
The percentage of patients with mean diurnal IOP < 18 mm Hg and short-term (daily) IOP fluctuation ≤ 2 mm Hg was significantly greater in the brimonidine-timolol group than in the brimonidine or timolol group at each follow-up visit (P ≤ .044). At each hour (8 AM, 10 AM, 3 PM, and 5 PM), the percentage of patients with mean IOP < 18 mm Hg and long-term (intervisit) IOP fluctuation ≤ 2 mm Hg was significantly greater with brimonidine-timolol than with brimonidine or timolol alone (P ≤ .006).
Patients treated with fixed-combination brimonidine-timolol were significantly more likely than patients treated with either brimonidine or timolol to achieve a combination of low mean IOP and low short-term (daily) or long-term (intervisit) IOP fluctuation. Fixed-combination brimonidine-timolol therapy may minimize the risk of visual field progression compared with either brimonidine or timolol alone by providing both low IOP and low fluctuation in IOP.
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