Long-term brimonidine therapy in glaucoma patients with apraclonidine allergy

PURPOSE: To report the use of brimonidine in patients with a documented ocu lar allergy to apraclonidine. METHODS: We conducted a prospective, open-label study on the use of long-te rm brimonidine therapy in 57 patients with chronic glaucoma with documented allergy to apraclonidine. The study patients were placed on brimonidine ta rtrate 0.2%, 1 drop three times daily in one or both eyes, either as additi ve therapy to a medical regimen devoid of apraclonidine for further lowerin g of intraocular pressure (25 patients) or as a replacement for apraclonidi ne at the time of diagnosis of apraclonidine ocular allergy for maintenance of intraocular pressure control (32 patients). Clinical symptoms and signs of ocular allergy to brimonidine were monitored for up to 18 months. RESULTS: During the treatment period of up to 18 months, six (10.5%) of 57 patients developed slit-lamp biomicroscopic findings and subjective symptom s of an ocular allergic reaction that led to discontinuation of brimonidine treatment. All six patients developed ocular allergy to topical brimonidin e 0.2% during the first 4 months of therapy. The addition of brimonidine 0. 2% topical medication or the replacement of apraclonidine with brimonidine resulted in a significant decrease in mean intraocular pressure from 20.5 /- 5.3 to 16.5 +/- 4.2 mm Hg (P < .0001) at the mean treatment period of 10 .6 +/- 4.6 months (range, 0.5 to 18.0 months in all 57 patients: 5 to 18 mo nths in the 51 patients without brimonidine allergy and 0.5 to 3.8 months i n the six patients who developed brimonidine allergy. CONCLUSIONS: The incidence of ocular allergy after the use of brimonidine 0 .2% topical medication for up to 18 months was 10.5% in patients with a doc umented history of apraclonidine allergy, Therefore, it is generally safe a s well as efficacious to administer brimonidine to patients with an ocular allergy to apraclonidine. (C) 1999 by Elsevier Science Inc. All rights rese rved.