Efficacy of brimonidine 0.2% as adjunctive therapy for patients with glaucoma inadequately controlled with otherwise maximal medical therapy

Purpose: To evaluate the clinical efficacy and tolerability of brimonidine tartrate 0.2% twice daily as adjunctive therapy for glaucoma patients inade quately controlled with otherwise maximal tolerated medical therapy. Design: Retrospective, noncomparative, case series. Participants: Ninety-six patients were identified from the authors' tertiar y glaucoma practice who were treated with brimonidine. Their glaucoma was u ncontrolled despite maximal tolerated medical therapy before receiving brim onidine, and some had previously undergone argon laser trabeculoplasty or f iltration surgery. The patients were subdivided according to their glaucoma diagnosis: open-angle (OAG), angle-closure (ACG), mixed mechanism, and con genital glaucoma. Both the short- (about 2 weeks) and long-term results wer e evaluated. Twenty-two patients were excluded because additional medicatio n changes were made at the time of introduction of brimonidine. Intervention: Brimonidine was added to the existing regimen of glaucoma med ication. Main Outcome Measures: Intraocular pressure (IOP) was recorded at all follo w-up dates, together with visual field examination and optic disc evaluatio n twice yearly. Results: There were 44 GAG, 20 ACG, 6 mixed mechanism, and 4 congenital gla ucoma patients. Mean pretreatment IOP, mean short-term post-treatment IOP, and mean short-term IOP reduction (percentage) were 23.10 +/- 5.21 mmHg, 18 .49 +/- 4.77 mmHg, and 4.6 mmHg (20%) for GAG; 22.80 +/- 5.70 mmHg, 18.65 /- 5.75 mmHg, and 4.15 mmHg (18%) for ACG; 25.00 +/- 10.32 mmHg, 21.00 +/- 12.12 mmHg, and 4.0 mmHg (16%) for mixed mechanism; and 26.00 +/- 4.97 mmHg , 17.75 +/- 4.57 mmHg, and 8.25 mmHg (32%) for congenital glaucoma, respect ively. Mean long-term follow-up was 204 days for OAG and 213 days for ACG. Of the initially controlled OAG and ACG patients, at 3 months 96% and 100%, at 6 months 80% and 77%, and at 9 months 58% and 44%, respectively, were s till controlled. Six patients discontinued brimonidine, three of these owin g to allergy. Conclusion: As adjunctive therapy, brimonidine achieved a short-term IOP re duction of 16%-32% in this patient population; 77%-80% of initially control led patients were still controlled after 6 months. Brimonidine was well tol erated.