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V. S. Yakopson, S. J. Donnelly, H. P. Fechter, W. R. Wilson; Brimonidine 0.1% vs Apraclonidine 0.5% for Prevention of Intraocular Pressure Elevation After Selective Laser Trabeculoplasty. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1234. doi: https://doi.org/.
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To compare the efficacy and safety of brimonidine 0.1% with those of apraclonidine 0.5% in preventing intraocular pressure (IOP) elevations after selective laser trabeculoplasty (SLT)
This was a prospective randomized double blind trial of 28 eyes of 14 patients who underwent SLT for primary open angle glaucoma and ocular hypertension. Enrolled patients were randomized to receive brimonidine 0.1% in one eye and apraclonidine 0.5% in the fellow eye. The trabecular meshwork in both eyes of each enrolled patient was treated 360 degrees at the same sitting. IOP was measured in each eye prior to applying the study medications and at one hour and one week after laser surgery
Mean pretreatment IOPs were 17.1 (σ 3.0) mmHg in the brimonidine 0.1% group and 18.5 (σ 4.3) mmHg in the apraclonidine 0.5% group (p= 0.018). Two patients with asymmetric IOPs were randomized to receive brimonidine in the eye with lower IOP. Excluding those two patients resulted in means of 16.5 (σ 2.7) mmHg and 17.2 (σ 2.9) mmHg (p=0.06). There was no difference in the IOP between the eyes pretreated with brimonidine vs apraclonidine at one hour after laser treatment: mean IOPs were 15.5 (σ 4.5) mmHg in the brimonidine group and 16.4 (σ 5.6) mmHg in the apraclonidine group (p=0.187). At one week the mean IOPs were 15.5 (σ 4.6) mmHg in the brimonidine group and 16.5 (σ 4.2) mmHg in the apraclonidine group (p=0.008). One patient did not follow up for the one week IOP check. One patient stopped taking his glaucoma drops five days post procedure. Excluding these two patients from both the one hour and one week groups yielded the following means: 15.3 (σ 4.8) mmHg and 15.8 (σ 5.4), at one hour (p= 0.297) and 15.2 (σ 4.6) and 16.3 (σ 4.3), at one week (p=0.008). There was no statistically significant difference in IOP between the preoperative and one hour postoperative and preoperative and one week postoperative IOPs within the brimonidine and apraclonidine groups (p's > 0.05). When the two non-compliant patients were excluded from the study a slight decrease in postoperative pressures both at one hour and one week was observed (p <0.05 but >0.01). Neither the brimonidine 0.1% nor the apraclonidine 0.5% group showed a mean IOP spike at one hour and one week following SLT
A single preoperative drop of brimonidine 0.1% had similar efficacy and safety as apraclonidine 0.5% in preventing IOP elevations immediately after selective laser trabeculoplasty in this study. There was a trend towards lower IOP at one week in eyes pretreated with brimonidine 0.1%
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