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Adewara BA, Singh S. Ocular Adnexal Changes After Antiglaucoma Medication Use. Int Ophthalmol Clin 2023; 63:47-58. [PMID: 37439609 DOI: 10.1097/iio.0000000000000456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
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Al-Essa RS, Abusayf MM, Alfawaz AM. Salmon patch-like conjunctival lesion secondary to long-term administration of topical brimonidine: A case report. Int J Surg Case Rep 2023; 108:108421. [PMID: 37352771 PMCID: PMC10382756 DOI: 10.1016/j.ijscr.2023.108421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/25/2023] Open
Abstract
INTRODUCTION Brimonidine is a commonly used intra-ocular pressure-lowering agent for glaucoma patients. Allergic follicular or papillary conjunctivitis is a well-known side effect of brimonidine. Brimonidine is associated with ocular allergic symptoms such as conjunctival hyperemia, stinging sensation, photophobia and, in severe cases, corneal erosions. Here, we report a case of atypical conjunctival lesion following long-term administration of brimonidine. CASE PRESENTATION We report the clinical findings of a 72-year-old female presenting with a salmon patch-like conjunctival lesion affecting the bulbar and palpebral conjunctiva after long-term use of brimonidine. The finding was suspicious of conjunctival lymphoproliferative disorders. However, upon cessation of brimonidine, along with the administration of short-course topical steroid, a complete resolution of the lesion was evident. Biopsy was not performed as the clinical picture improved with conservative management. No recurrence was observed over 1 year follow up. DISCUSSION Atypical conjunctival lesions have been described after long-term use of brimonidine. These lesions can mimic the appearance of conjunctival tumors, specifically conjunctival lymphoproliferative disorders, for which multiple investigations are required including invasive conjunctival biopsy. CONCLUSION Careful observation is recommended for patients with a history of long-term use of brimonidine for the development of atypical conjunctival lesions which may simulate the appearance of conjunctival lymphoproliferative disorders.
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Affiliation(s)
- Rakan S Al-Essa
- Department of Ophthalmology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Mohammed M Abusayf
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah M Alfawaz
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Ringuet J, Lajoie C, Bourgault S, Simonyan D, Houle MC. The Benefit Of Scratch Patch Testing To Demonstrate Ocular Contact Allergy To Brimonidine Tartrate. Contact Dermatitis 2022; 87:336-342. [PMID: 35642327 DOI: 10.1111/cod.14168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Ocular allergies to brimonidine are frequent in patients treated for glaucoma. There is variability in reporting due to the lack of diagnostic criteria and absence of cutaneous testing. Many false negative patch tests (PT) have been described. Alternative methods, such as strip and scratch PT, have been used without a standardized method. OBJECTIVES The primary objective is to identify the best method of cutaneous testing and brimonidine concentration for patch testing. The secondary objective is to identify clinical signs and symptoms suggestive of ocular allergy. PATIENTS AND METHODS A retrospective review of patient files suspected of brimonidine ocular allergy was performed. Patch testing method, brimonidine concentration and clinical symptoms were reviewed. RESULTS Of the 36 patients identified, half tested positive to brimonidine for at least one of the testing methods. The scratch PT demonstrated 17 positive reactions (94% detection rate). 3 patients reacted with strip PT. No positive results were found with standard PT. The 5% brimonidine concentration demonstrated the highest sensitivity. Absence of eyelid pruritus was associated with negative testing. CONCLUSION In the investigation of ocular allergy to brimonidine, scratch PT proved to be an essential tool. Brimonidine 5% pet. appeared as the most sensitive concentration for scratch PT.
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Affiliation(s)
- Julien Ringuet
- University Laval, Faculty of Medicine, Department of Dermatology, Québec, Canada.,Centre de Recherche Dermatologique du Québec Métropolitain (CRDQ), Québec, Québec, Canada
| | - Caroline Lajoie
- Département d'ophtalmologie et d'oto-rhino-laryngologie-chirurgie cervico-faciale, Faculté de médecine, Université Laval, Québec, Québec, Canada.,Centre universitaire d'ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec, Québec, Québec, Canada
| | - Serge Bourgault
- Département d'ophtalmologie et d'oto-rhino-laryngologie-chirurgie cervico-faciale, Faculté de médecine, Université Laval, Québec, Québec, Canada.,Centre universitaire d'ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec, Québec, Québec, Canada
| | - David Simonyan
- Clinical and Evaluative Research Platform, Centre Hospitalier Universitaire de Québec Research Center, Québec, Canada
| | - Marie-Claude Houle
- Department of Medicine, Division of Dermatology, Hôtel-Dieu de Québec, Université Laval, Québec, Canada
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Patchinsky A, Petitpain N, Gillet P, Angioi-Duprez K, Schmutz JL, Bursztejn AC. Dermatological adverse effects of anti-glaucoma eye drops: a review. J Eur Acad Dermatol Venereol 2022; 36:661-670. [PMID: 35032359 DOI: 10.1111/jdv.17928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/18/2021] [Indexed: 11/28/2022]
Abstract
Many patients are treated for glaucoma. Like other drugs, anti-glaucoma eye drops may induce dermatological adverse effects. We aim to review the dermatological adverse effects secondary to the active agents in anti-glaucoma eye drops through a literature review. In January 2020, we queried PubMed using the following MeSH terms: glaucoma/drug therapy or glaucoma, open angle/drug therapy cross-referenced with parasympathomimetics/adverse effects or adrenergic agonists/adverse effects or carbonic anhydrase inhibitors/adverse effects or prostaglandins F, synthetic/adverse effects or adrenergic beta antagonists/adverse effects or ophthalmic solutions/adverse effects. The initial search identified 1128 studies, of which 49 were excluded for being in a foreign language, 15 for not involving eye drops, 968 for not focusing on adverse dermatological effects, and 11 for insufficient documentation or redundancy. After adding 38 linked studies, we finally analysed 123 studies. The ocular and periocular dermatological adverse effects of eye drops are contact dermatitis, hyperpigmentation, prostaglandin analogue periorbitopathy, mucous membrane pemphigoid, eyelash depigmentation, skin hypertrichosis, and rare cases of melanoma and skin depigmentation. The reported distant dermatological adverse effects are psoriasis, excessive sweating, lichen planus, alopecia, toxic epidermal necrolysis, erythema multiforme, erythroderma, subacute cutaneous lupus erythematosus, nail pigmentation and bullous pemphigoid. Most of the cutaneous adverse effects of anti-glaucoma eye drops are ocular and periocular and induced by prostaglandin analogues. Distant adverse effects are rare and sometimes questionable but should be kept in mind, especially mucous membrane pemphigoid, which could lead to blindness. The role of preservatives, such as benzalkonium chloride, should also be considered.
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Affiliation(s)
- Alexandra Patchinsky
- Service de Dermatologie, CHRU DE NANCY Brabois, Bâtiment des Spécialités Médicales, rue de Morvan, 54511, Vandœuvre lès Nancy, France
| | - Nadine Petitpain
- Service de Pharmacovigilance, Bâtiment de Biologie Médicale et de Biopathologie, CHRU DE NANCY Brabois, rue de Morvan, 54511, Vandœuvre lès Nancy, France
| | - Pierre Gillet
- Service de Pharmacovigilance, Bâtiment de Biologie Médicale et de Biopathologie, CHRU DE NANCY Brabois, rue de Morvan, 54511, Vandœuvre lès Nancy, France.,Université de Lorraine, CNRS, IMoPA, F-54000, Nancy, France
| | - Karine Angioi-Duprez
- Service d'Ophtalmologie, Hôpital d'Adultes, CHRU DE NANCY Brabois, rue du Morvan, 54511, Vandœuvre lès Nancy, France
| | - Jean Luc Schmutz
- Service de Dermatologie, CHRU DE NANCY Brabois, Bâtiment des Spécialités Médicales, rue de Morvan, 54511, Vandœuvre lès Nancy, France
| | - Anne Claire Bursztejn
- Service de Dermatologie, CHRU DE NANCY Brabois, Bâtiment des Spécialités Médicales, rue de Morvan, 54511, Vandœuvre lès Nancy, France
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Yeh PH, Cheng YC, Shie SS, Lee YS, Shen SC, Chen HSL, Wu WC, Su WW. Brimonidine related acute follicular conjunctivitis: Onset time and clinical presentations, a long-term follow-up. Medicine (Baltimore) 2021; 100:e26724. [PMID: 34398046 PMCID: PMC8294862 DOI: 10.1097/md.0000000000026724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/01/2021] [Indexed: 01/04/2023] Open
Abstract
To evaluate the duration of topical brimonidine therapy before the onset of brimonidine-related allergic conjunctivitis and the clinical characteristics associated with the development of brimonidine allergy.We retrospectively enrolled patients who presented brimonidine allergy from December 1, 2008 to November 30, 2020. The duration of brimonidine treatment, concomitant medications, benzalkonium chloride (BAK) exposure, change in IOP, and season of onset were evaluated.292 patients were included, among which 147 were female and 145 were male. The mean age was 58.3 ± 13.6 years old. The mean (median) duration of brimonidine therapy was 266.6 (196) days, with a peak at 60-120 days. The duration was similar whether the patients received brimonidine monotreatment or in combination with other glaucoma drugs, with or without BAK. The IOP increased by 5.6% after brimonidine allergy (P < .001), which was even higher in the brimonidine monotherapy group (9.2%, P < .001). There was no significant IOP elevation in patients treated with multiple glaucoma medications.Around half of brimonidine allergy occurred within 6 months, with a peak in 2 to 4 months. The duration did not differ in patients receiving brimonidine monotherapy or multiple glaucoma medications. The presence of BAK did not affect the duration either. When brimonidine allergy occurred, there was a loss of IOP control, especially in patients receiving brimonidine monotherapy. It is recommended to switch to other types of glaucoma medications for better IOP control.
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Affiliation(s)
- Po-Han Yeh
- Department of Ophthalmology, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City
- Department of Ophthalmology
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Chun Cheng
- Department of Ophthalmology
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shian-Sen Shie
- Department of Internal Medicine, Chang Gung Memorial Hospital Linkou
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yung-Sung Lee
- Department of Ophthalmology
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Su-Chin Shen
- Department of Ophthalmology
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Henry Shen-Lih Chen
- Department of Ophthalmology
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wei-Wen Su
- Department of Ophthalmology
- Chang Gung University College of Medicine, Taoyuan, Taiwan
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Effect of over-the-counter brimonidine tartrate 0.025% ophthalmic solution on pupil size in healthy adults. Graefes Arch Clin Exp Ophthalmol 2021; 259:3333-3338. [PMID: 34251483 PMCID: PMC8523379 DOI: 10.1007/s00417-021-05297-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/09/2021] [Accepted: 06/24/2021] [Indexed: 11/09/2022] Open
Abstract
Purpose To evaluate the effect of brimonidine tartrate 0.025% ophthalmic solution on pupil size under scotopic conditions in healthy adults Methods Pupil size was measured in 56 eyes of 28 volunteer participants using a pupillometer under scotopic conditions. Age, gender, and iris color were recorded. Subjects using any ophthalmic medications other than artificial tears were excluded. The pupil size was subsequently measured again under scotopic conditions 60 min after instillation of brimonidine tartrate 0.025% ophthalmic solution. Results Statistically significant miosis was seen after instillation of brimonidine tartrate 0.025% (p = 0.04). Average pupil size prior to brimonidine 0.025% instillation was 7.28 ± 1.05 mm, and average pupil size after instillation of brimonidine 0.025% was 6.36 ± 1.68 mm, a reduction of − 23.7% in pupil area. Subjects with light irides demonstrated a greater miotic effect than subjects with dark irides (1.55 mm vs. 0.67 mm, p < 0.0001), with a pupil area reduction of − 37.6% and − 17.4%, respectively. The amount of miosis was independent of initial pupil size. Conclusions Brimonidine tartrate 0.025% causes significant miosis in scotopic settings, although the effect is not as great in darker colored eyes. Further studies are needed to determine the latency and duration of the effect and whether the amount of miosis is clinically significant.
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Phu J, Agar A, Wang H, Masselos K, Kalloniatis M. Management of open‐angle glaucoma by primary eye‐care practitioners: toward a personalised medicine approach. Clin Exp Optom 2021; 104:367-384. [DOI: 10.1111/cxo.13114] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Jack Phu
- Centre for Eye Health, The University of New South Wales, Sydney, Australia
| | - Ashish Agar
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Henrietta Wang
- Centre for Eye Health, The University of New South Wales, Sydney, Australia
| | - Katherine Masselos
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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Han YS, Ha A, Kim YK, Jeoung JW, Park KH. Normal-tension Glaucoma Management: A Survey of Glaucoma Sub-specialists in Korea. KOREAN JOURNAL OF OPHTHALMOLOGY 2020; 34:425-431. [PMID: 33307601 PMCID: PMC7738222 DOI: 10.3341/kjo.2020.0061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate the current management patterns of glaucoma subspecialists with regard to normal-tension glaucoma (NTG) in Korea and to determine the effect of the two largest NTG trials on their clinical practice. METHODS A questionnaire survey was sent to glaucoma subspecialist members of the Korean Glaucoma Society. The questionnaire concerned regular practice with respect to NTG and the extent to which it has been influenced by the Collaborative Normal-tension Glaucoma Study and the Low-pressure Glaucoma Treatment Study (LoGTS). RESULTS A total of 134 glaucoma subspecialists completed the survey, with a response rate of 56%. The survey reported that 88% and 78% of glaucoma subspecialists were familiar with the Collaborative Normal-tension Glaucoma Study and the LoGTS, respectively. With respect to mild or moderate NTG, most of the respondents (87%-91%) tended to treat their patients immediately without waiting for structural or functional progression. Among the respondents, 47 indicated that the LoGTS results-according to which, 20% of the respondents tended to use brimonidine more often-affected their management. The first-choice topical drugs for NTG were prostaglandin analogues (76%), brimonidine (9%), beta-blockers (8%), and topical carbonic anhydrase inhibitor (6%). CONCLUSIONS Regarding mild-to-moderate NTG, Korean glaucoma subspecialists tended to initiate treatment without waiting for further progression. The impact of the LoGTS on NTG management was not dominant in clinical practice in Korea. Prostaglandin analogs are the most frequently selected first-choice drugs for the management of NTG in Korea.
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Affiliation(s)
- Young Soo Han
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ahnul Ha
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Bae SH, Kim KW, Chun YS. Two Cases of Atypical Allergic Conjunctivitis Caused by Topical Administration of Brimonidine. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.10.1216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Park IK, Bae SH, Kim KW, Chun YS. Clinical Characteristics of Allergy to a Brinzolamide 1.0%/Brimonidine 0.2% Fixed Combination in Korean Glaucoma Patients. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.9.1065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Saito H, Kagami S, Mishima K, Mataki N, Fukushima A, Araie M. Long-term Side Effects Including Blepharitis Leading to Discontinuation of Ripasudil. J Glaucoma 2020; 28:289-293. [PMID: 30720574 DOI: 10.1097/ijg.0000000000001203] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PRECIS Blepharitis was the most common side effect leading to discontinuation of ripasudil therapy. Prior allergic reactions to other topical glaucoma were found to be a risk factor for ripasudil-induced blepharitis. PURPOSE To report the incidence proportion of blepharitis and its relating factors due to long-term use of 0.4% riapasudil, a Rho-kinase inhibitor, in glaucoma patients of a clinical setting. PATIENTS AND METHODS One hundred three eyes of 103 consecutive glaucoma patients who started ripasudil treatment between December 2014 and February 2017 at our institute, and who had a follow-up period of over 6 months were enrolled in this study. Incidence proportion, time required for recovery and risk factors associated with blepharitis and other side effects that led to discontinuation of ripasudil treatment were considered. RESULTS The most frequently observed side effect was blepharitis (25.2%). The 12- and 24-month discontinuation rate due to blepharitis was 21.1%±8.2% and 34.6%±11.8% (average±SE), respectively (Kaplan-Meier analysis). Most patients recovered from blepharitis symptoms within 4 weeks, but 5 patients required over 8 weeks for recovery. Past history of allergic reactions to other topical glaucoma medication was significantly correlated with the manifestation of blepharitis (Cox proportional hazard model, P<0.007) while age, sex, intraocular pressure reduction rate, number of administered eye drops, history of systemic allergic diseases were not. CONCLUSIONS Blepharitis was the most common reason for discontinuation of ripasudil treatment. Although most cases were resolved spontaneously, prolonged blepharitis was observed in a few patients. A past history of allergic reaction to other glaucoma medication indicates a higher possibility of blepharitis with ripasudil use and warrants careful administration.
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Affiliation(s)
| | - Shinji Kagami
- Dermatology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo
| | | | | | - Atsuki Fukushima
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi, Japan
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Rosenfeld E, Barequet D, Rabina G, Langier S, Lazar M, Shemesh G, Kurtz S, Kivity S. Effect of brimonidine tartrate on basophil activation in glaucoma patients. Int J Ophthalmol 2020; 13:509-512. [PMID: 32309191 DOI: 10.18240/ijo.2020.03.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/12/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the mechanism of which brimonidine tartrate 0.15% causes clinical hypersensitivity. METHODS A prospective case-control study comparing 8 glaucoma patients with clinical hypersensitivity to brimonidine to a control group consisting 13 healthy volunteers. Blood samples were stimulated with brimonidine 0.15%, timolol 0.5% or brimonidine tartrate/timolol maleate 0.2%/0.5%. Premixed antibodies (CD63/FITC and aIgE/PE) were added for direct staining and whole-blood samples were lysed, fixed and analyzed by a flow cytometer. The basophil population was defined by high IgE cell expression. Degranulation was identified by the expression of the activation molecule CD63. RESULTS Basophil activation was not significant when comparing percent of activated basophils of patients and healthy controls after exposure to brimonidine (2.58%, 2.45%, respectively, P=0.72). There was a significant suppression of basophil activation when a combination of brimonidine-timolol (0.87%) was compared to timolol (2.27%; P=0.012) and to brimonidine alone (2.58%; P=0.017). CONCLUSION The results of our study do not support the hypothesis that brimonidine induces an immediate allergic reaction. Basophil activation was suppressed by the presence of β-blockers in patients hypersensitive to brimonidine and in healthy individuals. This finding indicates that timolol suppress brimonidine drug reaction by a different mechanism.
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Affiliation(s)
- Eldar Rosenfeld
- Division of Ophthalmology, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Dana Barequet
- Division of Ophthalmology, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Gilad Rabina
- Division of Ophthalmology, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Sheila Langier
- Department of Allergy and Immunology, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Moshe Lazar
- Division of Ophthalmology, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Gabi Shemesh
- Division of Ophthalmology, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Shimon Kurtz
- Division of Ophthalmology, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Shmuel Kivity
- Department of Allergy and Immunology, Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
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Senthilkumar V, Mishra C. Brimonidine tartrate-induced delayed hypersensitivity reaction. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2020. [DOI: 10.4103/tjosr.tjosr_69_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hwang HB, Kim SY, Ohn K, Kim SY. Histopathologic Analysis of Conjunctival Lymphoproliferative Disease After Topical Brimonidine Use. J Ocul Pharmacol Ther 2019; 35:503-511. [PMID: 31373838 DOI: 10.1089/jop.2019.0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose: To describe of histopathological findings of conjunctival lymphoproliferative disease (CLD) after topical brimonidine use. Methods: This is a retrospective medical record review study, including histopathologic description. We reviewed the medical records of 208 patients (415 eyes) who were diagnosed with glaucoma and who were treated with topical brimonidine only for a minimum of 6 months. Of these, the medical records of 19 patients with suspected CLD clinical features were reviewed in detail. When CLD was suspected due to administration of brimonidine, histopathological analysis was performed by biopsy of these lesions. In addition, immunohistochemical staining was performed to analyze lymphocyte markers in some pathological tissues. Results: Nineteen patients had suspected CLD without definite irritative symptoms. Diffuse elevated (11 patients) or follicular lesion (8 patients) of salmon pink appearance was observed in inferior palpebral conjunctiva. Among these patients, 5 patients who agreed to conjunctival biopsy had histopathological findings of CLD such as reactive lymphoid hyperplasia (LH) (2 cases) or atypical LH (2 cases). The mean duration of brimonidine use was 29.00 ± 20.25 months (6-76 months). And follow-up period after discontinuation of brimonidine was 27.93 ± 11.87 months (12-58 months). At the last visit, complete resolution of the lesion was seen in 13 patients, and partial improvement was observed in 6 patients. Conclusions: We found 4 cases of CLD following long-term administration of brimonidine. However, large-scale additional studies should be performed to establish causality, to determine whether these novel side effects were caused by long-term brimonidine treatment.
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Affiliation(s)
- Hyung Bin Hwang
- Department of Ophthalmology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | | | - Kyoung Ohn
- Department of Ophthalmology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeoungbu, Republic of Korea
| | - Su-Young Kim
- Department of Ophthalmology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeoungbu, Republic of Korea
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Han J, Choi W, Lee WS, Bae HW, Kim CY, Seong GJ. The Relationship between Allergic Conjunctivitis due to Brimonidine and Systemic Allergic Disease in Glaucoma Patients. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.3.233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jongwook Han
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Wungrak Choi
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Won Seok Lee
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyoung Won Bae
- Institute of Vision Research, Department of Ophthalmology, Shinchon Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Yun Kim
- Institute of Vision Research, Department of Ophthalmology, Shinchon Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Gong Je Seong
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Kurysheva NI. [Selective α2-agonists in the treatment of glaucoma: pharmacology, efficacy and safety]. Vestn Oftalmol 2019; 135:144-150. [PMID: 31215546 DOI: 10.17116/oftalma2019135021144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Glaucoma is the main cause of irreversible blindness in the world. Among the hypotensive eye drops, an important place belongs to the selective α2-adrenergic receptor antagonist brimonidine. This part of the review focuses on key pharmacological and therapeutic characteristics of brimonidine and its mode of action. The article also discusses the side effects of brimonidine and the methods of their prevention.
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Affiliation(s)
- N I Kurysheva
- Ophthalmological Center of the Federal Medical-Biological Agency of the Russian Federation State Research Center ,Burnasyan Federal Medical Biophysical Center of the Federal Medical-Biological Agency, Academy of Postgraduate Education under FSBU FSCC of FMBA of Russia, Department of Opthalmology, 15 Gamalei St., Moscow, Russian Federation, 123098
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Oh DJ, Chen JL, Vajaranant TS, Dikopf MS. Brimonidine tartrate for the treatment of glaucoma. Expert Opin Pharmacother 2018; 20:115-122. [DOI: 10.1080/14656566.2018.1544241] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Daniel J. Oh
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Judy L. Chen
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Thasarat S. Vajaranant
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Mark S. Dikopf
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
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18
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Antiglaucoma Medications Complicating the Management of Graves’ Ophthalmopathy. Ophthalmic Plast Reconstr Surg 2018; 34:600-601. [DOI: 10.1097/iop.0000000000001230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Toxic keratoconjunctivitis (TK) is an underrecognized complication of ophthalmic drug use and various environmental or occupational exposures. A detailed history and clinical examination are important to identify the offending agent(s). Common drug-related causes of TK include preservatives in ophthalmic medications, topical antimicrobials, and topical anesthetics. Alternatives to benzalkonium chloride as well as preservative-free formulations should be considered in patients requiring long-term topical medication. More advanced cases of TK may require preservative-free topical steroids and/or antibiotics, and occasionally surgical intervention. Early recognition and appropriate management of TK may help prevent permanent ocular and visual damage.
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Park EJ, Chun YS. Comparison of Allergy Prevalence between Brimonidine/Timolol Fixed Combination and 0.15% Brimonidine in Glaucoma Patients. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.5.451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Eun Jung Park
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yeoun Sook Chun
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Lusthaus JA, Goldberg I. Brimonidine and brinzolamide for treating glaucoma and ocular hypertension; a safety evaluation. Expert Opin Drug Saf 2017; 16:1071-1078. [DOI: 10.1080/14740338.2017.1346083] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jed Asher Lusthaus
- Discipline of Ophthalmology, University of Sydney, Sydney, Australia
- Glaucoma Unit, Sydney Eye Hospital, Sydney, Australia
| | - Ivan Goldberg
- Discipline of Ophthalmology, University of Sydney, Sydney, Australia
- Glaucoma Unit, Sydney Eye Hospital, Sydney, Australia
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22
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Bangsgaard N, Fischer LAN, Zachariae C. Sensitization to and allergic contact dermatitis caused by Mirvaso(®) (brimonidine tartrate) for treatment of rosacea - 2 cases. Contact Dermatitis 2017; 74:378-9. [PMID: 27133629 DOI: 10.1111/cod.12547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 01/10/2016] [Accepted: 01/10/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Nannie Bangsgaard
- Department of Dermato-allergology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Louise A N Fischer
- Department of Dermato-allergology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Claus Zachariae
- Department of Dermato-allergology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
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23
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Broadway DC, Cate H. Pharmacotherapy and Adherence Issues in Treating Elderly Patients with Glaucoma. Drugs Aging 2015; 32:569-81. [PMID: 26136215 DOI: 10.1007/s40266-015-0282-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Glaucoma is a leading cause of visual morbidity throughout the world and is an age-related condition, the prevalence of which rises significantly with increasing age. Glaucoma, a condition affecting the optic nerve, has a variety of subtypes with multiple aetiological factors, the most important of which are intraocular pressure (IOP) and increasing age. Treatment by lowering of IOP is the only current method, for which there is evidence, by which the rate of progressive visual deterioration can be slowed or halted. Although there are surgical and laser treatments that are efficacious in lowering IOP, the most common manner in which patients with glaucoma control their IOP is with administration of daily topical ocular hypotensive drugs (eye drops). The variety of topical drugs utilised in the management of glaucoma all have the potential to have adverse effects and/or interactions with concomitant medications, many of which may be used for other age-related conditions. Adherence with appropriate medicines has a major effect on the outcome of medical conditions and this aspect applies to the management of glaucoma. There are certain specific issues that relate to the administration of topical agents, with respect to both adverse effects and adherence. Although many suspect poor adherence in elderly patients with glaucoma, relative to younger patients, adequate evidence for this is lacking. Furthermore, the manner by which adherence issues could be improved remains inadequately understood and poorly addressed. The aims of this article were to review, from a clinical perspective, the medical therapies currently used for glaucoma and discuss adherence issues with respect to the population of patients with glaucoma, who tend to be relatively elderly.
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Affiliation(s)
- David C Broadway
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UY, UK,
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Abstract
Primary open-angle glaucoma (POAG) is a leading cause of blindness with no known cure. Management of the disease focuses on lowering intraocular pressure (IOP) with current classes of drugs like prostaglandin analogs, beta-blockers, alpha-agonists, and carbonic anhydrase inhibitors. These treatments have not helped all patients. Some patients continue to experience deterioration in the optic nerve even though their IOPs are within the normal range. New views have surfaced about other pathophysiological processes (such as oxidative stress, vascular dysfunction, and retinal cell apoptosis) being involved in POAG progression, and adjunctive treatments with drugs like memantine, bis(7)-tacrine, nimodipine, and mirtogenol are advocated. This review examines the current and proposed treatments for POAG. Some of the proposed drugs (bis(7)-tacrine, nimodipine, vitamin E, and others) have shown good promise, mostly as monotherapy in various clinical trials. It is recommended that both the current and proposed drugs be put through further robust trials in concurrent administration and evaluated.
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Affiliation(s)
- Gabriel Beidoe
- Pharmaceutical Research Institute at Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USA
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Crawley L, Zamir SM, Cordeiro MF, Guo L. Clinical options for the reduction of elevated intraocular pressure. OPHTHALMOLOGY AND EYE DISEASES 2012; 4:43-64. [PMID: 23650457 PMCID: PMC3619493 DOI: 10.4137/oed.s4909] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Elevated IOP in clinical practice is usually seen in glaucoma or ocular hypertension. Glaucoma affects 60 million people worldwide and 8.4 million are bilaterally blind from this chronic disease.1 Options for reducing IOP rely on pharmacological agents, laser treatments and surgery which may be penetrating or non-penetrating. The last twenty years has seen significant changes in all of these strategies. This review aims to cover these clinical options and introduce some of the new technologies currently in development for the clinical lowering of IOP.
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Affiliation(s)
- Laura Crawley
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Maria F. Cordeiro
- Glaucoma and Retinal Neurodegeneration Research Group, Visual Neuroscience, UCL Institute of Ophthalmology, London, United Kingdom
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Li Guo
- Glaucoma and Retinal Neurodegeneration Research Group, Visual Neuroscience, UCL Institute of Ophthalmology, London, United Kingdom
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Arthur S, Cantor LB. Update on the role of alpha-agonists in glaucoma management. Exp Eye Res 2011; 93:271-83. [PMID: 21524649 DOI: 10.1016/j.exer.2011.04.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 04/03/2011] [Accepted: 04/04/2011] [Indexed: 11/19/2022]
Abstract
Glaucoma is the second most common cause of world blindness (following cataract) with estimated cases reaching 79.6 million by 2020. Although the etiology of glaucoma is multi-factorial, intraocular pressure (IOP) is the only modifiable factor in glaucoma management proven to alter the natural course of the disease. Among various classes of IOP-lowering medications currently available, alpha-adrenergic receptor agonists are used either as monotherapy, as second-line therapy, or in fixed combination with beta-blockers. Non-selective adrenergic agonists such as epinephrine and dipivefrin are infrequently used today for the treatment of glaucoma or ocular hypertension, and have been replaced by the alpha-2-selective agonists. The use of apraclonidine for IOP reduction in glaucoma or OHT is limited due to a high rate of follicular conjunctivitis. The alpha-2-selective agonist in use today is brimonidine. The brimonidine-purite formulations are preferred to brimonidine-benzalkonium chloride (BAC) formulations due better tolerability while maintaining similar efficacy. Brimonidine is also effective when used in combination with a beta-blocker. Using brimonidine-timolol fixed combination (BTFC) as first-line therapy has an added potential for neuroprotection. This would be a valuable strategy for glaucoma treatment, for patients who are intolerant of prostaglandin analogs, or for patients where prostaglandin analogues are contraindicated as first-line therapy, such as in patients with inflammatory glaucoma.
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Affiliation(s)
- Stella Arthur
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, 702 Rotary Circle, Indianapolis, IN 46202, USA
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Sullivan-Mee M, Pensyl D, Alldredge B, Halverson K, Gerhardt G, Qualls C. Brimonidine Hypersensitivity when Switching Between 0.2% and 0.15% Formulations. J Ocul Pharmacol Ther 2010; 26:355-60. [DOI: 10.1089/jop.2009.0153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael Sullivan-Mee
- Department of Surgery/section Optometry, Albuquerque VA Medical Center, Albuquerque, New Mexico
| | - Denise Pensyl
- Department of Surgery/section Optometry, Albuquerque VA Medical Center, Albuquerque, New Mexico
| | | | - Kathy Halverson
- Department of Surgery/section Optometry, Albuquerque VA Medical Center, Albuquerque, New Mexico
| | - Gretchen Gerhardt
- Department of Surgery/section Optometry, Albuquerque VA Medical Center, Albuquerque, New Mexico
| | - Clifford Qualls
- Department of Mathematics and Statistics, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Rodríguez Galietero A, González Martínez JV, Del Buey Á, Bescós JÁC. Use of Brimonidine Before LASIK With Femtosecond Laser-created Flaps forthe Correction of Myopia: A Contralateral Eye Study. J Refract Surg 2010; 26:28-32. [DOI: 10.3928/1081597x-20101215-04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 12/12/2008] [Indexed: 11/20/2022]
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Muñoz G, Albarrán-Diego C, Sakla HF, Javaloy J. Increased risk for flap dislocation with perioperative brimonidine use in femtosecond laser in situ keratomileusis. J Cataract Refract Surg 2009; 35:1338-42. [PMID: 19631117 DOI: 10.1016/j.jcrs.2009.03.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 02/26/2009] [Accepted: 03/12/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine whether brimonidine 0.2% minimizes the occurrence of subconjunctival hemorrhages without inducing postoperative flap complications in femtosecond laser in situ keratomileusis (LASIK). SETTING Centro Oftalmológico Marqués de Sotelo and Hospital NISA Virgen del Consuelo, Valencia, Spain. METHODS This prospective contralateral-eye interventional study evaluated consecutive patients who had bilateral simultaneous femtosecond LASIK for myopia (spherical equivalent [SE] range -1.00 to -8.00 diopters) performed with an IntraLase femtosecond laser and a Visx Star 2 excimer laser. One eye of each patient received a single drop of brimonidine tartrate 0.2% (brimonidine group) and the other eye, a single drop of a balanced salt solution (control group). RESULTS The study evaluated 136 eyes (68 patients). The difference in the incidence of subconjunctival hemorrhages was statistically significantly lower in the brimonidine group (mean score 2.24 +/- 1.96 [SD]) than in the control group (mean score 7.61 +/- 2.72) (P<.001). However, no eye in the control group and 7 eyes (10.4%) in the brimonidine group had a dislocated flap with folds on the first postoperative day (P = .016). All eyes with dislocated flaps required surgical intervention. At 6 months, there was no significant difference between groups in the percentage of eyes achieving 20/20 or better uncorrected distance visual acuity, in the mean SE, or in the enhancement rate. CONCLUSIONS Brimonidine prevented the formation of subconjunctival hemorrhages after femtosecond LASIK but increased the risk for flap dislocation. Thus, surgeons are cautioned against the use of perioperative brimonidine to decrease hemorrhagic complications in femtosecond LASIK.
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Affiliation(s)
- Gonzalo Muñoz
- Refractive Surgery Department, Centro Oftalmológico Marqués de Sotelo and Hospital NISA Virgen del Consuelo, Valencia, Spain.
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Pérez-Rodríguez E, González-Pérez R, Poza P, Feliciano L, López-Correcher B, Matheu V. Contact dermatitis caused by latanoprost-containing eye drops with good tolerance to bimatoprost eye drops. Contact Dermatitis 2008; 58:370-1. [DOI: 10.1111/j.1600-0536.2007.01297.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Loon SC, Liew G, Fung A, Reid SE, Craig JC. Meta-analysis of randomized controlled trials comparing timolol with brimonidine in the treatment of glaucoma. Clin Exp Ophthalmol 2008; 36:281-9. [PMID: 18412600 DOI: 10.1111/j.1442-9071.2008.01720.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This paper aims to compare the efficacy and tolerability of timolol versus brimonidine in the treatment of glaucoma. Comprehensive searches were performed using Medline, Embase and the Cochrane Controlled Trials Register for randomized controlled trials comparing timolol and brimonidine. Two reviewers independently assessed trials for eligibility and quality and extracted data. A random effects model was used to combine studies. Outcome was defined as the absolute mean intraocular pressure (IOP) reduction from baseline to end-point for efficacy, and relative risk (RR) for adverse events. Subgroup analysis and meta-regression were used to explore heterogeneity according to trial design and quality. Ten publications reporting on eight trials with 2387 participants were included in the meta-analysis. Two further trials were commented on qualitatively. IOP reduction was not significantly different between timolol and brimonidine. Weighted mean difference (WMD) of IOP reduction was 0.24 mmHg (favouring brimonidine) with a 95% confidence interval of -0.57 to 1.04 mmHg. There was significant heterogeneity between studies (chi(2) (13) = 73.75, P < 0.00001, I(2) = 91%). Subgroup analysis showed no significant WMD for studies where data were analysed from end-points >/=6 months or <6 months. Meta-regression analysis showed increased WMD IOP reduction in favour of brimonidine with increased trial quality (t(3) = -4.58, P = 0.01), but no significant association with trial duration (t(3) = 0.73, P = 0.51) or size (t(3) = -0.59, P = 0.57). The RR of ocular allergy was much lower with timolol than brimonidine (RR = 0.08, 95% confidence interval 0.01 to 0.47). Publication bias was not evident on a funnel plot, although the number of studies was small. The conclusion is that both drugs are equally effective in lowering IOP. Brimonidine is associated with a higher rate of allergy.
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Affiliation(s)
- Seng Chee Loon
- National University Hospital, Singapore; and Department of Ophthalmology, Centre for Vision Research, Millenium Institute, University of Sydney, Westmead, Sydney, New South Wales, Australia.
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Aristodemou P, Baer R. Reversible cicatricial ectropion precipitated by topical brimonidine eye drops. Ophthalmic Plast Reconstr Surg 2008; 24:57-8. [PMID: 18209648 DOI: 10.1097/iop.0b013e31815c95e9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Bilateral cicatricial ectropian was precipitated by topical brimonidine eye drops. On discontinuation of the drug, the ectropian resolved. Patients on brimonidine who develop cicatricial ectropian should not be managed surgically at first presentation.
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Affiliation(s)
- Petros Aristodemou
- Department of Ophthalmology, Royal United Hospital, Bath, Avon, United Kingdom.
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Kim CY, Hong S, Seong GJ. Brimonidine 0.2% versus brimonidine Purite 0.15% in Asian ocular hypertension. J Ocul Pharmacol Ther 2008; 23:481-6. [PMID: 17900227 DOI: 10.1089/jop.2007.0042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the efficacy and safety of brimonidine 0.2% versus brimonidine Purite 0.15% in Asians with ocular hypertension. METHODS This study was a prospective, randomized, observer-masked, short-term crossover trial. Eighty-six (86) Asian subjects with newly diagnosed ocular hypertension were randomly assigned to receive either brimonidine 0.2% or brimonidine Purite 0.15%, both dosed twice a day for 4 weeks. Subjects were then washed out for 6 weeks and switched to the opposite treatment for 4 weeks. RESULTS The baseline intraocular pressure (IOP) was 24.4 +/- 2.45 mmHg for brimonidine 0.2% and 24.39 +/- 2.56 mmHg for brimonidine Purite 0.15% (P = 0.985). The IOP was at trough drug effect after 4 weeks of brimonidine 0.2% and brimonidine Purite 0.15% therapy were 20.10 +/- 2.01 mmHg and 21.00 +/- 1.67 mmHg (P = 0.001), respectively. The IOP at peak drug effect after 4 weeks of brimonidine 0.2% and brimonidine Purite 0.15% treatment were 18.10 +/- 1.73 mmHg and 18.20 +/- 1.71 mmHg (P = 0.518), respectively. Brimonidine 0.2% was found to cause more allergic conjunctivitis than brimonidine Purite 0.15% (P < 0.001). CONCLUSIONS Brimonidine 0.2% has a higher potency of lowering IOP than brimonidine Purite 0.15% at trough when used twice-daily. However, ocular allergic reaction was more frequent and severe with brimonidine 0.2% than with brimonidine Purite 0.15%.
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Affiliation(s)
- Chan Yun Kim
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
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Randazzo A, Nizzola F, Rossetti L, Orzalesi N, Vinciguerra P. Pharmacological management of night vision disturbances after refractive surgery. J Cataract Refract Surg 2005; 31:1764-72. [PMID: 16246781 DOI: 10.1016/j.jcrs.2005.02.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of diluted aceclidine eyedrops in reducing night vision disturbances after refractive surgery. SETTING Department of Ophthalmology, Istituto Clinico Humanitas, Rozzano-Milano, Italy. METHODS This double-masked randomized clinical trial included 30 patients (60 eyes) with chronic night vision disturbance after refractive surgery. Patients were randomly allocated to receive (1) placebo, (2) aceclidine 0.016%, or (3) aceclidine 0.032%. Drugs were administered once or twice daily. Anterior segment, haze, uncorrected visual acuity, best corrected visual acuity, intraocular pressure, corneal maps, and scotopic pupil size were determined at baseline and at follow-up examinations (15 and 30 days after inclusion). Halos and double vision 4-step scales were built to determine subjective grading of night vision disturbance, and the root mean square (RMS) was calculated to determine objective changes in night vision disturbance. RESULTS The effect of diluted aceclidine started about 15 minutes after instillation and lasted for about 5 hours. No difference between the 2 dilutions could be found. Thirty-nine of 40 treated eyes showed a reduction in night vision disturbance. The mean reduction in halos and double vision grading was 1.42 +/- 0.5 (SD) and 1.14 +/- 0.4, respectively. A mean decrease in pupil size of 2.5 mm was measured. Thirty minutes after the instillation of diluted aceclidine, the topography-derived wavefront error showed a statistically significant reduction in RMS values (total, spherical, astigmatic, coma, and higher order), which was maintained for 5 hours. A transitory conjunctival hyperemia was the only side effect reported. CONCLUSION Diluted aceclidine seemed to be an effective and safe treatment for night vision disturbance following refractive surgery.
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Affiliation(s)
- Alessandro Randazzo
- Department of Ophthalmology, Istituto Clinico Humanita-Rozzano, Modena, Italy.
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Bhatt R, Whittaker KW, Appaswamy S, Desai A, Fitt A, Sandramouli S. Prospective survey of adverse reactions to topical antiglaucoma medications in a hospital population. Eye (Lond) 2004; 19:392-5. [PMID: 15297863 DOI: 10.1038/sj.eye.6701515] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIM To identify the relative incidence and profile of adverse drug reaction (ADR) to various topical ocular hypotensives in a hospital setting. METHODS All the patients presenting in outpatients clinic and accident and emergency with an ADR to topical hypotensive agent from August 2000 to January 2001 were included in the study. Details regarding the type date of commencing the treatment, the date of developing ADR, time to resolution of the ADR were noted. RESULTS Over the period of 6 months, 66 patients presented with 73 ADRs. Brimonidine was the most frequent offending agent. In total, 23 (34.8%) presented with ADR after being commenced on treatment for more than 12 months. In all, 16 (24%) patients had IOP > 21 on presentation, eight (12%) patients underwent filtration surgery following the development of ADR. CONCLUSION Adverse drug reaction to ocular hypotensive agents is not uncommon and can have a major impact on glaucoma management. Delayed presentation and association with raised intraocular pressure presentation emphasise the need for effective patient education to encourage prompt reporting of ADR.
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Affiliation(s)
- R Bhatt
- Wolverhampton & Midland Counties Eye Infirmary, Wolverhampton WV3 9QR, UK
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Manni G, Centofanti M, Sacchetti M, Oddone F, Bonini S, Parravano M, Bucci MG. Demographic and Clinical Factors Associated with Development of Brimonidine Tartrate 0.2%-Induced Ocular Allergy. J Glaucoma 2004; 13:163-7. [PMID: 15097264 DOI: 10.1097/00061198-200404000-00014] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify demographic and clinical characteristics associated with the development of brimonidine tartrate 0.2%-induced ocular allergy. PATIENTS AND METHODS In this retrospective study, 133 patients affected by primary open-angle, pigmentary, narrow angle, or pseudo-exfoliative glaucoma and treated with brimonidine tartrate 0.2% were divided into two groups: allergic and non allergic to brimonidine tartrate 0.2%. The distribution of demographic (age and sex), local (history of allergic conjunctivitis, previous eye-drop ocular allergy, use of other concurrent topical medications, amount of topical medications previously used, use of contact lenses, and tear film production), and systemic (history of systemic allergies and use of systemic drugs) factors was evaluated by comparing the brimonidine tartrate 0.2% allergic and the non-allergic groups. RESULTS In this study, 13.5% of patients (18 of 133) developed brimonidine ocular allergy generally within two weeks from the beginning of treatment (mean time 14.8 +/- 17.9 days). The brimonidine tartrate 0.2% allergic group showed a significantly higher frequency of history of ocular allergy to eye-drops (P = 0.048) and to topical beta-blockers (P = 0.019) when compared with the brimonidine tartrate 0.2% non-allergic group. Moreover, the allergic group showed a decreased tear film production (P = 0.044). CONCLUSION This study showed that history of eye-drop allergies and reduction of tear film production were more frequently associated with the development of brimonidine tartrate 0.2%-induced ocular allergy.
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Affiliation(s)
- Gianluca Manni
- University of Rome "Tor Vergata," Department of Ophthalmology, Italy
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Cates CA, Jeffrey MN. Granulomatous anterior uveitis associated with 0.2% topical brimonidine. Eye (Lond) 2003; 17:670-1. [PMID: 12855989 DOI: 10.1038/sj.eye.6700392] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2002; 11:529-44. [PMID: 12426939 DOI: 10.1002/pds.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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