Efficacy of brimonidine when added to maximally tolerated glaucoma medications

Purpose: We use apraclonidine HCL (A) to lower intraocular pressure (IOP), thus avoiding surgery. In some individuals a local allergy limits its use. Brimonidine tartrate (B), an investigational α₂-agonist may be an alternative. Methods: We retrospectively reviewed charts of 26 glaucoma patients, from two glaucoma specialists, who had been treated with both (B) 0.2% and 0.5%, after failing to achieve adequate control of IOP, while on maximum-tolerated medications. Six patients had a prior history of having had developed an allergic reaction to (A) and were subsequently treated with (B). Results: The patients' ages ranged from 40 to 90 years, mean 64 years. Eleven (42%) discontinued (B) because of lack of efficacy. We discontinued four (15%) due to undesirable side effects. Most common complaints were dry mouth, and blurry vision. One experienced CNS sedation. Of the 6 patients allergic to (A), the treatment duration of (B) ranged from 19 to 84 weeks, mean 49.7 weeks, with 5 of the 6 patients remaining on (B). One was discontinued due to non-compliance. The mean pretreatment IOP were 20.2 ± 5.2 and 20.8 ± 4.1, right and left eyes respectively. The mean treated IOP's were 18.7 ± 7.7 and 19.2 ± 5.4, decrease of 12% and 13%, for right and left eyes respectively. Conclusions: Patients who had previously developed an allergic reaction while on (A) have been better able to tolerate (B), however its long-term use may be short due to its efficacy.