Efficacy of apraclonidine 1% versus pilocarpine 4% for prophylaxis of intraocular pressure spike after argon laser trabeculoplasty

Objective: The authors compared the efficacy of apraclonidine 1% versus pil ocarpine 4% prophylaxis of post-argon laser trabeculoplasty (ALT) intraocul ar pressure (IOP) spike. Design: Prospective randomized clinical trial, Participants: Two hundred twenty-eight eyes of 228 patients with primary op en-angle glaucoma undergoing ALT were studied, Intervention: Patients were given 1 drop of either apraclonidine 1% (n = 11 4) or pilocarpine 4% (n = 114) 15 minutes before ALT. Main Outcome Measures: Peri-ALT IOPs and incidences of post-ALT IOP spikes at 5 minutes, 1 hour, and 24 hours were compared between the two groups, Results: The two groups were similar in age, race, and medical-dependency. Post-ALT mean IOPs at 5 minutes, 1 hour, and 24 hours were significantly lo wer than pre-ALT mean IOPs in both apraclonidine (P < 0.001) and pilocarpin e (P < 0.001) groups. Incidences of IOP spikes greater than 1, 3, and 5 mmH g at 1 hour post-ALT were 21.1 %, 14.9%, and 8.8% for the apraclonidine gro up and 12.3%, 5.3%, and 4.4% for the pilocarpine group (P = 0.076, 0.015, a nd 0.18 chi-square test), In the apraclonidine prophylaxis group, patients on long-term apraclonidine showed significantly higher incidence of post-AL T IOP spike than the patients without such long-term apraclonidine use (35. 7%, 15 of 42 eyes, vs. 12.5%, 9 of 72 eyes; P = 0.003). In addition, peri-A LT pilocarpine prophylaxis tended to be less effective in patients undergoi ng long-term pilocarpine therapy but without statistical significance (17.4 %, 8 of 46 eyes, vs, 9.4%, 6 of 64 eyes; P = 0.17). Conclusion: Peri-ALT pilocarpine 4% was at least as effective as, if not mo re effective than, apraclonidine I% in post-ALT IOP spike prophylaxis. Peri -ALT apraclonidine prophylaxis was not effective in patients on long-term a praclonidine, and peri-ALT pilocarpine prophylaxis tended to be less effect ive in patients undergoing long-term pilocarpine therapy. Pilocarpine 4% ca n be considered as a first-choice drug for post-ALT IOP spike prophylaxis, especially in patients under treatment with apraclonidine.