SHORT-TERM EFFICACY OF APRACLONIDINE HYDROCHLORIDE ADDED TO MAXIMUM-TOLERATED MEDICAL THERAPY FOR GLAUCOMA

PURPOSE: We determined whether the addition of topical apraclonidine h ydrochloride to eyes that are receiving maximal medical therapy but st ill have inadequate intraocular pressure control and that are schedule d to undergo surgery could adequately decrease intraocular pressure, p ostponing the need for further intervention. METHODS: We performed a p rospective, 90-day, multicentered, placebo-controlled, double-masked p arallel study. We enrolled one eye each of 174 glaucoma patients with inadequate intraocular pressure control who were on maximally tolerate d medical therapy. We continued to administer maximum medical therapy for glaucoma, Study medications were either apraclonidine hydrochlorid e 0.5% or placebo (apraclonidine's vehicle). Patients were instructed to take the study medication every eight hours. We measured intraocula r pressure, change in intraocular pressure from baseline, and the numb er of eyes requiring surgery after the addition of study medication. R ESULTS: Fifty-two (60%) of 86 patients treated with apraclonidine main tained adequate intraocular pressure control throughout the study and avoided surgery, compared with 28 (32%) of 88 patients treated with pl acebo (P < .001). Apraclonidine treatment resulted in significantly mo re patients attaining an additional 20% reduction or more in intraocul ar pressure from baseline and an intraocular pressure less than or equ al to 20 mm Hg (P < .05). The most common ocular complication was conj unctival hyperemia (11 of 86 patients, 12.8%), The most frequent nonoc ular problem was dry mouth (four patients, 4.7%). CONCLUSION: Apraclon idine appeared to be safe in all eyes and efficacious in some eyes. It significantly lowered intraocular pressure when used in combination w ith maximally tolerated medical therapy, which delayed or prevented fu rther glaucoma surgery for at least 90 days in 52 (60%) of 86 treated patients.