Avaliação do colírio de brimonidina 0,2% em comparação à nafazolina 0,025% + feniramina 0,3% nas cirurgias de estrabismo / Evaluation of 0.2% brimonidine eye drops compared to 0.025% naphazoline + 0.3% pheniramine in strabismus surgery

RESUMO Objetivo: Avaliar o efeito do colírio de brimonidina 0,2% na redução da hiperemia e do sangramento ocular durante as cirurgias de estrabismo, em comparação com o colírio de nafazolina 0,025% + feniramina 0,3%. Métodos: Foram avaliados 14 pacientes com estrabismo e indicação de correção cirúrgica bilateral. Foi instilado antes do procedimento, de forma aleatória, um colírio em cada olho dos pacientes avaliados. A análise subjetiva da hiperemia conjuntival e do sangramento perioperatório foi realizada de forma duplo-cega, por dois cirurgiões. A avaliação objetiva do nível de hiperemia conjuntival foi realizada por análise das imagens obtidas por meio do software ImageJ®. Resultados: A análise de modelos multivariados de efeito misto indicou diferenças estatisticamente significantes entre os grupos em relação à hiperemia (avaliador 2) e ao sangramento intraoperatório (avaliadores 1 e 2), com maiores escores nos casos tratados com colírio de nafazolina + feniramina. Entretanto, não houve diferença estatística na análise objetiva realizada por meio da saturação de cores obtidas pelo programa ImageJ®. Conclusão: O colírio de brimonidina pode ser superior ao colírio de nafazolina + feniramina na redução do sangramento, levando-se em conta apenas a análise subjetiva.

ABSTRACT Objective: To evaluate the effect of 0.2% brimonidine eye drops in reducing hyperemia and ocular bleeding during strabismus surgeries, in comparison with 0.025% naphazoline + 0.3% pheniramine eye drops. Methods: Fourteen patients with strabismus and indication for bilateral surgical correction were evaluated. Before the procedure, the eye drops were instilled randomly in each eye of the evaluated patients. The subjective analysis of conjunctival hyperemia and perioperative bleeding was performed in a double-blind manner, by 02 surgeons. The objective assessment of the level of conjunctival hyperemia was performed by analyzing the images obtained using the ImageJ® software. Results: The analysis of multivariate mixed effect models indicated statistically significant differences between the groups in relation to hyperemia (rater 2) and intraoperative bleeding (raters 1 and 2) with higher scores in cases treated with naphazoline + pheniramine eye drops. However, there were no statistically significant differences in the objective analysis of color saturation obtained by the ImageJ® program. Conclusion: Brimonidine eye drops may be superior to naphazoline + pheniramine eye drops in reducing bleeding, taking into account the subjective analysis only.

Effect of brimonidine on central corneal thickness in normal tension glaucoma patients

Background: Brimonidine is a potent ocular hypotensive agent widely used in glaucoma treatment. A reduction in central corneal thickness can lead to an underestimation of intraocular pressure by Goldmann applanation tonometry and vice versa. The aim of this study is to determine whether brimonidine has an effect on central corneal thickness.Methods: 30 eyes of patients who attended the Ophthalmology OPD between the time period October 2017 and June 2018 who were newly diagnosed with normal tension glaucoma with no history of any systemic illness or not on any medication were included. Each patient underwent a complete ophthalmic evaluation including fundus examination, visual field assessment, intraocular pressure, central corneal thickness measurement by pachymetry before as well as 1 month and 6 months after starting treatment with 0.2% topical brimonidine twice daily.Results: Administration of brimonidine 0.2% resulted in an increase in central corneal thickness from 525±21 µm before starting brimonidine to 528±21 µm (p<0.05) after 1 month and 535±20 µm (p<0.001) after 6 months. It also resulted in a reduction in intraocular pressure from an initial value of 16±2 mmHg before starting brimonidine to 14±2 mmHg (p<0.05) and 13±2 mmHg (p<0.05), 1month and 6 months after starting treatment, respectively.Conclusions: The data presented in this study show that topical administration of 0.2% brimonidine twice daily results in a significant increase in central corneal thickness in patients with normal tension glaucoma.

Brimonidine-induced unilateral ocular lichen planus: a case report / Líquen plano ocular unilateral induzido por brimonidina: relato de caso

ABSTRACT This report was written to describe a case of unilateral brimonidine-induced conjunctival lichen planus. Because the ophthalmic examination indicated chronic conjunctivitis or drug-induced pseudopemphigoid, the patient underwent thorough ophthalmic and systemic examinations, as well as conjunctival biopsy and direct immunofluorescence studies. A 71-year-old woman with unilateral left eye findings of chronic conjunctivitis was referred to our Ophthalmology Department. The patient reported that chronic conjunctivitis began shortly after she initiated use of topical brimonidine. Ophthalmic examination revealed foreshortening of the inferior fornix and symblepharon. Conjunctival biopsy revealed submucous lymphocytes and shaggy distribution of fibrinogen on direct immunofluorescence; this was suggestive of ocular lichen planus. No other systemic lesions were found that were consistent with the presentation of lichen planus. A good response was observed to topical cyclosporine treatment. To our knowledge, this may be the first report of unilateral ocular lichen planus without systemic findings. The correlation with the initiation of topical brimonidine suggests that this might be the first case of biopsy-confirmed brimonidine-induced ocular lichen planus.

RESUMO Este relato é para descrever um caso de líquen plano conjuntival unilateral induzido por brimonidina. Como o exame oftalmológico indicava conjuntivite crônica ou pseudopenfigóide induzido por medicamento, o paciente foi submetido a exames oftalmológicos e sistémicos completos, além de biópsia conjuntival e estudos de imunofluorescência direta. Uma mulher de 71 anos de idade com achados unilaterais do olho esquerdo de conjuntivite crônica foi encaminhada ao nosso departamento de Oftalmologia. A paciente relatou que a conjuntivite crônica começou logo após o início do uso da brimonidina tópica. O exame oftalmológico revelou encurtamento do fórnice inferior e do symblepharon. A biópsia conjuntival revelou linfócitos submucosos e distribuição felpuda de fibrinogênio na imunofluorescência direta; isso era sugestivo de líquen plano ocular. Não foram encontradas outras lesões sistêmicas compatíveis com a apresentação do líquen plano. Uma boa resposta foi observada no tratamento tópico com ciclosporina. Pelo nosso conhecimento, este pode ser o primeiro relato de líquen plano ocular unilateral sem achados sistêmicos. A correlação com o início da brimonidina tópica sugere que este pode ser o primeiro caso de líquen plano ocular induzido por brimonidina confirmado por biópsia.

Clinical Effectiveness of a Brinzolamide 1%-Brimonidine 0.2% Fixed Combination for Normal Tension Glaucoma in South Koreans

PURPOSE: This study evaluated the efficacy and safety of a brinzolamide 1%-brimonidine 0.2% fixed combination (BBFC) for normal tension glaucoma (NTG) in a South Korean population. METHODS: This study included 45 patients who were newly diagnosed with NTG and treated with BBFC as the first therapy from January 2016 through December 2016. The unilateral eye of NTG eyes of all patients were enrolled. If both eyes were eligible, the eye with the more severe glaucomatous change was selected. If the glaucomatous change was similar in both eyes, the right eye was selected. The patients received the BBFC twice a day. Diurnal intraocular pressure (IOP) was measured every 2 and 1/2 hours between 09:00 am and 04:30 pm. The IOP change with respect to body position (positional IOP) was measured at baseline and at 6 months after eyedrop instillation. Throughout the study, all side effects were recorded and monitored by the investigators. RESULTS: Ten patients were excluded due to an allergic reaction or follow-up loss. A total of 35 patients were enrolled in this study. The mean IOP was 15.32 ± 4.00 mmHg at baseline and 13.38 ± 3.30 mmHg at 6 months after BBFC instillation (p < 0.001). The IOP fluctuation decreased from 3.33 ± 3.10 to 2.35 ± 1.40 mmHg after BBFC instillation; however, the difference was not statistically significant (p = 0.150). The mean change in positional IOP showed a statistically significant reduction from 16.94 ± 3.18 to 14.80 ± 3.27 mmHg (p = 0.025). There was no serious adverse drug reaction except in three cases of allergic reaction. CONCLUSIONS: BBFC is effective for the reduction of mean IOP and positional IOP in NTG patients.

Comparison of Allergy Prevalence between Brimonidine/Timolol Fixed Combination and 0.15% Brimonidine in Glaucoma Patients

PURPOSE: To compare the allergy prevalence and clinical manifestations of 0.2% brimonidine/0.5% timolol fixed combination (BTFC) and 0.15% brimonidine in Korean patients with glaucoma. METHODS: We retrospectively analyzed the medical records of 196 glaucoma patients treated with BTFC and 234 glaucoma patients treated with 0.15% brimonidine. We compared sex, age, type of glaucoma, treatment period, allergy history, onset time of ocular allergy and clinical characteristics of allergy in the two groups. RESULTS: Ocular allergy percentages 10.14% in the BTFC group and 22.02% in the 0.15% brimonidine group, and the risk of allergy was approximately 0.4 times lower in patients using BTFC (hazard ratio = 2.5, p = 0.009). The BTFC group developed ocular allergy at a mean of 20.5 months (range: 1.7–51.1 months), and the 0.15% brimonidine group developed ocular allergy at a mean of 7.7 months (range: 0.4–50.8 months). In the BTFC group, 50% of the ocular allergy occurred within 15 months, and within 5 months in the 0.15% brimonidine group. Clinical characteristics of brimonidine allergy involved two types of conjunctival follicles and conjunctival papillae, but there were no significant differences in incidence according to allergy type (p = 0.566). CONCLUSIONS: The prevalence of ocular allergy in the BTFC group was lower than that in the 0.15% brimonidine group in Korean patients with glaucoma. The results of this study are expected to be useful for patient education and compliance improvement using brimonidine.

Neuroprotective effects of brimonidine on retinal ganglion cells induced by oxidative stress mitochondrial dysfunction / 中华实验眼科杂志

Objective To explore whether brimonidine has a protective effect on retinal ganglion cells (RGCs) through improving mitochondrial function under the oxidative stress.Methods Mouse RGC-5 cells were cultured in DMEM medium containing low concentration of glucose (1 g/L),10％ fetal bovine serum and 100 U/ml penicillin-streptomycin solution.The cells were divided into normal control group,H2O2-treated group and brimonidine+ H2O2 group.H2O2 at the concentration of 800 μmol/L was added into the medium in the H2O2-treated group,and 1 μmol/L brimonidine was added into the medium for 2 hours prior to the addition of H2O2 in the brimonidine+H2O2 group.The cells were sequently cultured for 24 hours.The morphology of the cell nucleus was examined by Hoechst fluorscence staining.The expressions of apoptosis-related protein in the cells were detected by Western blot assay.Mitochondrial membrane potential was assessed by JC-1 staining.Results The cell nuclei showed round or oval in shape with consistent size in the normal control group.The pycnosis and karyorrhexis of the cell nuclei were seen in the H2O2-treated group,and less abnormal nuclei were found in the brimonidine+H2O2 group.The relative expression level of bcl-2 protein in the cells was 0.76±0.15,0.50±0.13 and 0.75±0.17 in the normal control group,H2O2-treated group and brimonidine + H2O2 group,respectively,and the expression of bcl-2 protein in the H2O2-treated group was significantly lower than that in the normal control group and brimonidine+H2O2 group (both at P＜0.05).The relative expression level of bax protein in the cells was 0.65±0.13,0.83±0.07 and 0.70±0.10 in the normal control group,H2O2-treated group and brimonidine+H2O2 group,respectively,and the expression of bax protein in the H2O2-treated group was significantly higher than that in the normal control group and brimonidine+H2O2 group (both at P＜0.05).A strong orange fluorescence was seen in the mitochondrial membrane of RGC-5 in the normal control group with a coexpression with the green fluorescence of cell membrane.In the H2O2-treated group,the orange fluorescence intensity in the cells was evidently weakened,and the number of JC-1 responsed cells was considerably increased and the orange fluorescence intensity was enhanced in the brimonidine + H2O2 group.Conclusions Brimonidine can prevent RGCs from oxidative-stress damage by improving the mitochondrial function and therefore play a potential neuroprotective effect on optic nerve.

Microdialysis Recovery of Brimonidine Tartrate in Vitro and in Vivo / 中国药学杂志

OBJECTIVE: To evaluate the effects of drug concentration and perfusion rate on the recoveries of self-made linear microdialysis probes for further ocular pharmacokinetic study. METHODS :Brimonidine tartrate was selected as the model drug. The in vitro recovery was determined using positive dialysis and retrodialysis at different perfusion rates and drug concentrations. And the in vivo recovery was determined using retrodialysis method. RESULTS: The microdialysis recoveries of brimonidine tartrate were inversely proportional to perfusion rate,while independent of drug concentration. The positive dialysis and retrodialysis recoveries in vitro were different at 1.0 μL•min-1, but no significant difference at 2.0 and 3.0 μL•min-1. The in vitro recoveries were greater than those in vivo. CONCLUSION: The self-made microdialysis probe has stable recovery and can be used in ocular pharmacokinetic study of brimonidine tartrate.

Unilateral floppy eyelid syndrome with ipsilateral intolerance to brimonidine / Síndrome da palpebral flácida unilateral com intolerância a brimonidina ipsilateral

Abstract The authors report a case of unilateral floppy eyelid syndrome with ipsilateral intolerance to brimonidine in a 65-year-old man. The singularity of this case is the combination of two rare illnesses of great phlogistic potentiality in the same eye. The purpose of this article is to report a case of unilateral floppy eyelid syndrome with ipsilateral intolerance to brimonidine, emphasizing a possible relation between them. The result was a unilateral keratopathy that emulated an intraepithelial neoplasia. The key to solving the problem was an unexplained anterior uveitis that raised the suspicion of drug toxicity.The upper eyelid eversion of the affected eye during sleep seemed to be the common denominator of both ailments. The bizarre aspect of the epitheliopathy most likely resulted from the combination of trauma, insufficient lubrication, and drug intolerance.

Resumo Os autores relatam um caso de síndrome da pálpebra flácida unilateral com intolerância ipsilateral à brimonidina em um homem de 65 anos de idade. A singularidade deste caso é a combinação de duas doenças raras de grande potencialidade inflamatória no mesmo olho. O objetivo deste artigo é relatar um caso de síndrome da pálpebra flácida com intolerância ipsilateral à brimonidina, enfatizando uma possível relação entre eles. O resultado foi uma ceratopatia unilateral que simulou uma neoplasia intra-epitelial. A chave para resolver o problema foi uma uveíte anterior inexplicável que levantou a suspeita de toxicidade medicamentosa. A eversão da pálpebra superior do olho afetado durante o sono parece ser o denominador comum de ambas as doenças. O aspecto bizarro da epiteliopatia provavelmente resultou da combinação de trauma, lubrificação insuficiente e intolerância ao medicamento.

The effect of single dose of brimonidine-purite 0.15％ on choroidal thickness in healthy volunteers / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the potential posterior segment effects of topical application of brimonidine-purite 0.15％ through measurement of choroidal thickness (CT) in healthy eyes using enhanced depth imaging spectraldomain optical coherence tomography (EDI-SD-OCT).METHODS:Thirty-two eyes of 32 healthy subjects were included in this prospective,placebo controlled interventional clinical trial.They received one drop of topical preservative-free artificial tears as placebo for the first day and one drop of brimonidine-purite 0.15％ for the second day.Intraocular pressure,ocular perfusion pressure (OPP),and EDI-SD-OCT were performed at baseline,at 1,3 and 5h after the treatments.RESULTS:Compared to the measurements obtained at baseline,the CT measurements obtained after the topical application of brimonidine-purite 0.15％ significantly increased at the sub-fovea (P=0.001),at temporal 1500 μm to the fovea (P=0.003) and at nasal 1500 μm to the fovea (P=0.003).Choroidal thickness was unchanged in placebo group during the study (P ＞0.05).There was no significant reduction in the OPP in both groups (P ＞0.05).There were no adverse events during the study.CONCLUSIONS:Contrary to expectations,topical administration of brimonidine-purite 0.15％ resulted with thickening of sub-foveal,temporal and nasal CT.This might be related to altered auto-regulation mechanisms in choroidal vessels.

Recent advances in treatment of Leber's hereditary optic neuropathy / 眼科新进展

Leber's hereditary optic neuropathy (LHON) is an inherited mitochondrial disorder characterized by bilateral progressive vision loss.Current management includes therapies directed at enhancing mitochondrial function and preventing oxidative damage.This article reviews the progress of treatments from mitochondria cocktail,idebenone,gene therapy,EPI-743,brimonidine,traditional Chinese medicine and physical therapy,providing a new insight in the treatments of LHON.

The Efficacy of Brinzolamide 1%/Brimonidine 0.2% Fixed Combination in Normal Tension Glaucoma

PURPOSE: To evaluate the efficacy and safety of brinzolamide 1%/brimonidine 0.2% fixed combination (BBFC) in normal tension glaucoma (NTG) patients. METHODS: This prospective study included patients treated with brinzolamide 1% monotherapy, brimonidine 0.2% monotherapy or brinzolamide 1% and brimonidine 0.2% concomitant therapy, as well as newly diagnosed NTG patients. The enrolled patients who used brinzolamide 1% or brimonidine 0.2% switched to BBFC and newly diagnosed NTG patients were treated with BBFC. The patients receiving brinzolamide 1% or brimonidine 0.2% monotherapy or brinzolamide 1% and brimonidine 0.2% concomitant therapy switched antiglaucoma drugs to BBFC. Newly diagnosed NTG patients used BBFC as the first therapy. The study consisted of 1 screening/baseline visit and 3 follow-up visits conducted after 1, 4, 8, 12 and 24 weeks of treatment. Intraocular pressure (IOP), mean deviation value and adverse drug reactions were evaluated before treatment and after treatment with BBFC. RESULTS: The mean IOP in the brinzolamide 1% monotherapy group was 13.5 ± 1.6 mm Hg and the mean IOP after switched from brinzolamide 1% monotherapy to BBFC was 12.1 ± 1.5 mm Hg. The mean IOP in the brimonidine 0.2% monotherapy group was 14.2 ± 1.3 mm Hg and the mean IOP after switched from brimonidine 0.2% monotherapy to BBFC was 11.7 ± 1.5 mm Hg. The mean IOP was 11.9 ± 2.1 mm Hg in the brinzolamide 1% and brimonidine 0.2% concomitant therapy group and the mean IOP after switched from brinzolamide 1% and brimonidine 0.2% concomitant therapy to BBFC was 12.0 ± 1.1 mm Hg. The mean IOP and reduction rate were 10.7 ± 2.1 mm Hg and 35.5%, respectively,in the newly diagnosed NTG patients treated with BBFC. There was no serious adverse drug reaction causing ocular damage. CONCLUSIONS: BBFC provides a significant IOP reduction and is a safe antiglaucoma medication for NTG patients.

A comparative study on safety and efficacy of travoprost and brimonidine/timolol fixed combination in patients of primary open‑angle glaucoma.

Background: The purpose of this study was to compare and evaluate the clinical efficacy of topically applied travoprost 0.004% eye drops versus brimonidine/timolol fixed combination eye drops in the management of primary open-angle glaucoma. Methods: In this prospective, randomized study, 65 patients received either travoprost eye drops once daily in the morning (n=33) or brimonidine/timolol fixed combination eye drops twice daily (n=32). Intra ocular pressure (IOP) was assessed at 2, 4, 8, and 12 weeks. The primary outcome measure was mean reduction in IOP. Results: The baseline mean IOP values were similar between two groups. Mean reduction of IOP in the right eye for brimonidine/timolol fixed combination group was 9±2.9 mmHg, whereas in the left eye it was 10.9±2.8 mmHg. In the travoprost group, the reduction in IOP of the right eye was 7.8±2.9 mmHg (p=0.0002) and 7.5±3.4 mmHg (p=0.0001) in the left eye. The mean reduction of IOP for the brimonidine/timolol group was 9.95 mmHg and for the travoprost group it was 7.6 mmHg (p<0.0001) in both the eyes. Conclusions: The fixed combination brimonidine/timolol twice daily demonstrated superior mean IOP lowering efficacy compared to travoprost 0.004% in patients with open-angle glaucoma.

Comparison of Latanoprost and Brimonidine in the treatment of open angle glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AlM:To compare the efficacy and safety of latanoprost and brimonidine in the treatment of open angle glaucoma, and provide reference for rational drug use.METHODS:A total of 121 cases ( 136 eyes ) who were diagnosed as primary open angle glaucoma were selected in this study, and they were randomly divided into experimental group (62 cases, 70 eyes) and control group ( 59 cases, 66 eyes) according to different drug treatment. Patients in the control group received brimonidine eye drops twice a day, while patients in the experimental group received latanoprost eye drops once a day. The intraocular pressure, visual acuity and adverse reactions were checked of the two groups in the following 3mo.RESULTS:The intraocular pressure of patients in the control group was 18. 1 ± 1. 3mmHg, while the experimental group was 17. 0 ± 0. 9mmHg after 12wk of treatment, which were both lower than before (P<0. 05). The fluctuation of intraocular pressure in the experimental group was significantly lower than that of the control group. There was no significant difference in the LogMAR visual acuity between before and after treatment in the control group, while the LogMAR visual acuity of the experimental group was significantly improved. The control group had hyperemia, burning sensation, tearing, eyelid edema and other adverse side effects, and the experimental group had little adverse reactions. CONCLUSlON: Latanoprost can significantly reduce intraocular pressure in glaucoma patients with in the follow- up time, and reduce the impact of elevated intraocular pressure in the vision of glaucoma patients, with little adverse reaction, worthy of clinical application.

Evaluation of brimonidine-timolol fixed combination in patients of primary open-angle glaucoma.

mean reduction in intraocular pressure were compared between brimonidine‑timolol fixed combination with brimonidine and timolol, it was found to be statistically significant (P < 0.05) at 2 weeks and highly significant (0.001) at 6 weeks. The overall frequency of adverse effects was similar in all three groups.

A comparison of the efficacy and safety of timolol in combination with dorzolamide, brimonidine or latanoprost in patients of primary open angle glaucoma.

The present study was undertaken to compare the efficacy and safety of timolol with dorzolamide, brimonidine or latanoprost in patients of primary open angle glaucoma. This prospective, observational study was conducted over one and a half year at the Regional Eye Institute, in patients of primary open angle glaucoma who were prescribed dorzolamide (2%) and timolol (0.5%) (DT), brimonidine (0.1%) and timolol (0.5%) (BT) or latanoprost (0.005%) and timolol (0.5%) (LT). Measurement of intraocular pressure (IOP) and indirect ophthalmoscopy was done at baseline and after 1, 3 and 6 months of treatment. Efficacy was assessed by the degree of reduction in intraocular pressure and change in cup-disc ratio. Adverse drug reactions (ADRs), if any, were recorded. The data was analysed using Student’s ‘t’ test and one-way ANOVA test. P value < 0.05 was considered to be statistically significant. Total number of 35 patients in DT group, 34 in BT group and 32 in LT group completed the study. At the end of 6 months, average reduction in IOP levels was 7.83, 9.39 and 9.73mmHg in DT, BT and LT groups respectively. Thus, a percent reduction of 29.4, 35.6 and 36.2 from baseline was observed in these groups respectively. While the reduction was maximum in LT group, there was no statistically significant difference between any of the groups at 1, 3 or 6 months. A total of 47 ADRs were reported, none of which required discontinuation. All three combinations are effective in reducing the IOP level in patients of primary open angle glaucoma and none appear to be superior to the others.

In-Vitro Dissolution Study and Shelf Life Calculation of Developed Sol-To-Gel Ocular Drug Delivery System of Brimonidine for Conjunctivitis during Accelerated Stability Study.

The present research work deals with the in- vitro dissolution study of developed sol to gel ocular drug delivery system of brimonidine for conjunctivitis during accelerated stability study. The formulation of brimonidine was developed and optimized formulation coded as X4Y2D containing optimized amount of sodium alginate and HPMC K100LvP was evaluated for the physico-chemical characterization and drug release initially and during accelerated stability study. The drug release was determined using fabricated continuous flow through cell apparatus. The difference between initial drug release and after three month drug release was 2.606% and the calculation was done for shelf life and found 2 years.

Efficacy and Cardiovascular Safety of Topical Timolol, Brimonidine & Latanoprost in Newly Diagnosed Patients of Open Angle Glaucoma.

The present study was conducted in chronic open angle glaucoma patients to evaluate their efficacy in reducing IOP and their cardiovascular safety. 48 newly diagnosed patients of glaucoma completed the trial. Patients were divided into three groups and received medications in form of topical instillations. Group I (Timolol 0.5% twice a day), Group II (Brimonidine Tatrate 0.2% twice a day) & Group III (Latanoprost 0.005% once a day) for 12 weeks. All the three medications, significantly decreased IOP (P<0.05), however, Latanoprost caused maximum decrease in IOP, followed by Brimonidine and Timolol. Visual Acquity was not affected by any of the medication. Pulse Rate and PR Interval were decreased in Timolol group significantly (P < 0.001) while Brimonidine and Latanoprost did not alter Pulse Rate. Blood Pressure was not affected by either of medication except Brimonidine which caused reduction in systolic Blood Pressure at 12 weeks. The results of present study demonstrates superiority of Latanoprost over Timolol and Brimonidine as it lacked effect on Pulse Rate, Blood Pressure and HR, besides being more efficacious.

A Case of Herpetic Simplex Keratitis after Application of 0.015% Tafluprost Eye Drops

PURPOSE: To report a single case of herpes simplex keratitis after application of 0.015% tafluprost eye drops. CASE SUMMARY: A 68-year-old male presented with left eye discomfort, epiphora, decreased visual acuity and hyperemia. The patient was diagnosed with glaucoma 6 weeks prior and started on 0.015% tafluprost eye drops in left eye and 0.15% brimonidine in both eyes. On slit lamp examination dendritic epithelial defect was observed and the patient was diagnosed with herpes simplex keratitis. The 0.015% tafluprost treatment was discontinued and 0.15% brimonidine was applied in both eyes twice a day. The herpetic keratitis in his left eye resolved completely in 2 weeks with acyclovir ointment and oral antiviral agent. No further recurrence was observed in the following 3 months.

Clinical effectiveness and safety of brimonidine (0.2%) versus Dorzolamide (2.0%) in primary open angle.

A Comparison of efficacy & tolerability of brimonidine (0.2%) versus dorzolamide (2.0%) in primary open angle glaucoma or ocular hypertension. In this open, randomized, cross over comparative study, 30 subjects of primary open angle glaucoma with IOP > 22 mmHg were taken. The patients fulfilling the inclusion criteria and after verifying the exclusion criteria were included in the study after a written informed consent. These subjects were randomized to receive brimonidine (0.2%) TDS or dorzolamide (2.0%) TDS for 4 weeks. After a wash out period of 4 weeks the subjects were crossed over to other therapy .The IOP was measured at 8.00 am before dosing and at 10.00 am i.e. 2 hours after dosing at each baseline and at the end of each treatment period. Monotherapy with brimonidine (0.2%) TDS and dorzolamide (2.0%) TDS given for 4 weeks had caused overall reduction in IOP of 5.833+2.102mmHg (23.48%) and 5.433+ 2.582mmHg (22.42%) respectively at peak levels. The difference is statistically insignificant (p>0.05). Overall monotherapy with brimonidine and dorzolamide appear to produce equivalent IOP lowering efficacy and have well tolerated adverse effect profile, although a trend was observed at 10.00 a.m. of greater brimonidine efficacy compared with dorzolamide.

Changes in the Lacrimal Excretory System Depending on the Administration Mode of Brimonidine Tartrate: Spray vs. Irrigation

PURPOSE: To investigate the effects of 0.15% brimonidine tartrate ophthalmic solution spray on the luminal changes in the nasolacrimal excretory system. METHODS: A prospective study was performed on 52 eyes in 26 patients complaining of epiphora in both eyes. The randomly-assigned 26 test eyes (cases) received spray of the solution through the nasal cavity, and the other 26 eyes (controls) were irrigated with the same drug through the inferior calnaliculus. Dacryocystography was then performed to observe the luminal changes jn the nasolacrimal excretory system, patient symptoms and physiologic drainage functions. RESULTS: The changes in lumen width of the nasolacrimal duct (NLD) were noted, and the changes in lumen width of the lacrimal sac were not significant in either mode. The upper and middle parts of the NLD were widened more in the irrigation group, and the lower part of the NLD was widened more in the spray group. Though there was no significant difference in the physiologic drainage functions, the patients in both groups reported reduced symptoms. CONCLUSIONS: Brimonidine tartrate spray altered the width of the NLD and improved the subjective symptoms of patients. Therefore, the spray can be applied in functional NLD obstruction patients before the surgical procedure.