A. Sciscio et Ag. Casswell, Effectiveness of apraclonidine 1% in preventing intraocular pressure rise following macular hole surgery, BR J OPHTH, 85(2), 2001, pp. 164-168
Aim-To determine the efficacy of apraclonidine hydrochloride 1% in preventi
ng intraocular pressure (IOP) spikes following idiopathic macular hole (IMH
) surgery with platelet adjunct and intraocular gas tamponade.
Methods-This is a prospective, double masked, randomised study to compare a
praclonidine hydrochloride 1%, an a, agonist, with a placebo in the prevent
ion of IOP rises following macular hole surgery. Each patient was randomly
selected to receive either the study drug or the placebo; one drop was inst
illed in the conjunctival sac 2 hours preoperatively and on completion of t
he procedure. IOP was measured at baseline and at 1, 3, 6, 24, 48 hours, an
d 2 weeks postoperatively. Blood pressure and heart rate were also recorded
at baseline and at 3 and 24 hours postoperatively. Macular hole repair sur
gery was performed as standardised in the unit with a vitrectomy, platelet
concentrate, and complete fill of the vitreous cavity with perfluoropropane
gas (C3F8) at a concentration of 16%.
Results-25 patients (26 eyes) were enrolled. 12 eyes received apraclonidine
hydrochloride 1% (mean age 70.7; range 62-78 years) and 14 eyes received t
he placebo (mean age 70.0; range 57-81 years). At baseline evaluation the m
ean IOP was 15.6 mm Hg for the study group and 14.3 mm Hg for the placebo g
roup. The mean postoperative IOP at 1 hour, 3 hours, 6 hours, and 24 hours
was 10.6, 9.6, 8.2, and 14.0 mm Hg in the apraclonidine group. In the contr
ol group at the same time intervals the mean IOP was 23.4, 17.5, 19.2, and
24.7 mm Hg. These readings were statistically significant different: 1 hour
(p=0.0001); 3 hours (p=0.0015); 6 hours (p<0.0001); and 24 hours (p=0.019)
, the readings at 48 hours and 2 weeks were not statistically significant d
ifferent (p=0.15 and p=0.59). Only one of the patients in the study group h
ad an IOP above 25 mm Hg at any time. In the control group an IOP above 25
mm Hg was found in seven patients (50%) at the 1 hour postoperative measure
ment. At 2 weeks the IOP was recorded below 25 mm Hg in all patients. No st
atistically significantly difference was noted between the two groups regar
ding the systolic or diastolic blood pressure values and the heart rate rec
ords. No local or systemic adverse reactions were observed.
Conclusions-Apraclonidine hydrochloride 1% appears to be an efficacious and
safe drug in the prophylaxis of early postoperative IOP elevations in pati
ents undergoing macular hole surgery.