Brimonidine 0.2% versus apraclonidine 0.5% for prevention of intraocular pressure elevations after anterior segment laser surgery

Objective: To compare the efficacy of brimonidine 0.2% with apraclonidine 0 .5% in preventing intraocular pressure (IOP) elevations after anterior segm ent laser surgery. Design: Double-masked, randomized clinical trial. Participants: Sixty-six patients underwent either laser peripheral iridotom y, argon laser trabeculoplasty, or neodymium:yttrium-aluminum-garnet laser capsulotomy. Intervention: Eyes received either one drop of brimonidine 0.2% or apraclon idine 0.5% before laser surgery. Main Outcome Measures: Intraocular pressure, heart rate, and blood pressure were measured before laser surgery and at 1 hour, 3 hours, 24 hours, and 1 week after laser surgery. Results: Before the laser treatment, 33 patients (50.0%) received brimonidi ne 0.2% and 33 patients (50.0%) received apraclonidine 0.5%. Eight of 33 pa tients (24.2%) in the brimonidine-treated group and 9 of 33 patients (27.3% ) in the apraclonidine group had postoperative IOP increases of 5 mmHg or m ore. This was not statistically different (P = 0.80). By the time of last f ollow-up examination, 3 of 33 patients (9.1%) in the brimonidine-treated gr oup and 3 of 33 patients (9.1%) in the apraclonidine group had IOP increase s of 10 mmHg or more. This was also not statistically different (P greater than or equal to 0.95). The mean IOP reduction from baseline in the brimoni dine group (-2.8 +/- 2.8 mmHg) was not statistically different (P = 0.55) c ompared with the mean IOP reduction in the apraclonidine group (-3.6 +/- 3. 3 mmHg). There were no statistically significant changes in mean heart rate or blood pressure in either group except for a slight reduction in diastol ic blood pressure at 1 hour(P = 0.005) in the brimonidine group (-5.2 +/- 7 .4 mmHg) compared with the apraclonidine group (-0.2 +/- 6.4 mmHg). There w ere no clinically significant side effects noted in either group. Conclusions: A single preoperative drop of brimonidine 0.2% is as effective as apraclonidine 0.5% in preventing IOP elevation immediately after anteri or segment laser surgery. Ophthalmology 2001;108:1033-1038 (C) 2001 by the American Academy of Ophthalmology.