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

摘要

PURPOSE: To evaluate the clinical efficacy and tolerability of brimonidine tartrate 0.2% twice daily as adjunctive therapy for glaucoma patients inadequately controlled with otherwise maximal tolerated medical therapy. DESIGN: Retrospective, noncomparative, case series. PARTICIPANTS: Ninety-six patients were identified from the authors' tertiary glaucoma practice who were treated with brimonidine. Their glaucoma was uncontrolled despite maximal tolerated medical therapy before receiving brimonidine, and some had previously undergone argon laser trabeculoplasty or filtration surgery. The patients were subdivided according to their glaucoma diagnosis: open-angle (OAG), angle-closure (ACG), mixed mechanism, and congenital glaucoma. Both the short- (about 2 weeks) and long-term results were evaluated. Twenty-two patients were excluded because additional medication changes were made at the time of introduction of brimonidine. INTERVENTION: Brimonidine was added to the existing regimen of glaucoma medication. MAIN OUTCOME MEASURES: Intraocular pressure (IOP) was recorded at all follow-up dates, together with visual field examination and optic disc evaluation twice yearly. RESULTS: There were 44 OAG, 20 ACG, 6 mixed mechanism, and 4 congenital glaucoma 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 OAG; 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, respectively. 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 still controlled. Six patients discontinued brimonidine, three of these owing to allergy. CONCLUSION: As adjunctive therapy, brimonidine achieved a short-term IOP reduction of 16%-32% in this patient population; 77%-80% of initially controlled patients were still controlled after 6 months. Brimonidine was well tolerated.