The Efficacy of Apraclonidine as an Adjunct to Timolol Therapy

Stewart, William C.

doi:10.1001/archopht.1995.01100030041019

Cited by 44 publications

(18 citation statements)

References 22 publications

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“…However, it is also effective in POAG treatment as ‘primer’ drug or adjunct to timolol treatment [17]. Çeliker et al [18]speculated that topical apraclonidine has a local vasoconstrictive effect on the OA without changing the vascular parameters both in the CRA and PCA.…”

Section: Discussionmentioning

confidence: 99%

The One-Month Effects of Topical Betaxolol, Dorzolamide and Apraclonidine on Ocular Blood Flow Velocities in Patients with Newly Diagnosed Primary Open-Angle Glaucoma

et al. 2001

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Purpose: This double-masked, prospective and randomized clinical trial was planned to investigate with color Doppler imaging the 1-month vascular effects of betaxolol, dorzolamide and apraclonidine treatment on patients with newly diagnosed primary open-angle glaucoma (POAG). Methods: 22 consecutive patients with newly diagnosed POAG between the ages of 46 and 72 years were enrolled in this study. All patients were newly diagnosed cases and had not received any antiglaucoma medication before. Patients who had a systemic vascular disease (including systemic hypertension) or were taking β-blockers, nitrates or calcium channel blockers were excluded from the study. The patients were randomly divided into three groups. Groups A and B contained 7 patients, group C contained 8 patients. Group A patients were treated with topical betaxolol, group B patients received topical dorzolamide eye drops, and group C patients were treated with topical apraclonidine eye drops. Peak systolic velocities (PSV), end-diastolic velocities (EDV) and resistive indices (RI) in the right ophthalmic arteries (OA), central retinal arteries (CRA) and posterior ciliary arteries (PCA) were measured at baseline by using color Doppler imaging on a masked basis. On days 15 and 30 of treatment, the same measurements were repeated. The inter- and intragroup results were compared statistically. Results: Compared to pretreatment measurements, topical betaxolol therapy significantly decreased PSV only in the PCA and only on day 30 of treatment (p = 0.011). On days 15 and 30, dorzolamide decreased RI measurements in the PCA compared to pretreatment measurement (p = 0.013 and p = 0.011, respectively). Apraclonidine also decreased PSV in the OA on days 15 and 30 of treatment when compared to pretreatment values (p = 0.013 and p = 0.012, respectively). When 15-day measurements were compared between the groups, PSV in the OA were significantly higher in dorzolamide-treated patients compared to other groups (p = 0.01 and p = 0.011). On day 30 of treatment, PSV in the OA was also higher in the dorzolamide-treated group than the other groups (p = 0.012 and p = 0.01). Additionally, apraclonidine-treated patients had a significantly lower EDV in the OA than the other groups (p = 0.013 and p = 0.01). The RI in the OA was also significantly lower in the apraclonidine-treated group compared to the other groups (p = 0.01 and p = 0.011). Conclusion: Our study suggests that dorzolamide has the most advantageous 1-month effects on blood flow velocity in the retrobulbar arterial circulation of POAG patients. Betaxolol seems superior to apraclonidine in this regard. Our data may help the clinician when treating patients with POAG medically. Further studies using a larger population size may clarify our results.

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Section: Discussionmentioning

confidence: 99%

The One-Month Effects of Topical Betaxolol, Dorzolamide and Apraclonidine on Ocular Blood Flow Velocities in Patients with Newly Diagnosed Primary Open-Angle Glaucoma

et al. 2001

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“…Apraclonidine has been demonstrated to have an additive IOP-lowering effect when used in combination with a β-blocker [4, 5, 6]. Both timolol and apraclonidine appear to reduce IOP by decreasing aqueous formation [16, 17, 18].…”

Section: Discussionmentioning

confidence: 99%

“…Both timolol and apraclonidine appear to reduce IOP by decreasing aqueous formation [16, 17, 18]. When administered to patients receiving timolol on a long-term basis, apraclonidine produced an additional 14–18% reduction in aqueous flow [4, 5, 6]. It has been theorized that with long-term β-blockage, a basal rate of cAMP synthesis exists in ciliary processes that can be suppressed with the α-adrenergic agonists.…”

Section: Discussionmentioning

confidence: 99%

“…Reduction of elevated intraocular pressure (IOP) with α 2 -agonists has proved to be an exciting new therapeutic approach for the treatment of glaucoma [1, 2, 3]. In short- and long-term studies ranging from 1 to 90 days, apraclonidine produced a significant additional reduction in IOP when used as an adjunct to timolol maleate [4, 5, 6]. Brimonidine tartrate is a new relatively selective α 2 -agonist that, because of its distinct chemical structure, may have theoretical advantages over apraclonidine [7].…”

Section: Introductionmentioning

confidence: 99%

“…In these patients, a second agent such as pilocarpine, an adrenergic agonist or dorzolamide may be added. However, because these second-line agents have side effects that limit their use in many patients [4, 5, 6, 13, 14, 15], there is a need for a well-tolerated agent that provides an additional decrease in IOP in glaucoma patients who are already on β-blocker therapy.…”

Section: Introductionmentioning

confidence: 99%

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The Short-Term Effect of Adding Brimonidine 0.2% to Timolol Treatment in Patients with Open-Angle Glaucoma

Yüksel

Altıntaş²,

Karabaş³

et al. 1999

Ophthalmologica

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Brimonidine, a highly selective α₂-adrenoceptor agonist, was studied to determine its ocular hypotensive effect and side effects in patients with elevated intraocular pressure (IOP) while on continuing therapy with timolol. This was a prospective, randomized, placebo-controlled study in 15 patients with primary open-angle or pseudoexfoliation glaucoma on therapy receiving timolol 0.5% twice daily, with IOP greater than or equal to 22 mm Hg in one eye. IOP measurements, blood pressure and pulse rate were assessed on 2 days at a baseline and 1, 2, 4, 6 and 8 h later. A single drop of brimonidine 0.2% or placebo was added to treatment with timolol. The reductions in IOP at all time intervals observed with brimonidine + timolol were significantly greater than those with timolol + placebo. The maximum mean net decrease in IOP was 19.23 ± 10.60% at 4 h. Statistically significant decreases in systemic blood pressure and pulse rate without clinical symptoms were observed in the group receiving brimonidine + timolol. This study suggests that a combination of brimonidine and timolol may have potential in the treatment of glaucoma. Further clinical trials with brimonidine are indicated to assess its further role as adjunctive agent.

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β-Blocker–Induced Complications and the Patient With Glaucoma

Stewart¹,

Garrison²

1998

Arch Intern Med

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Primary open-angle glaucoma is a condition associated with an elevated intraocular pressure (IOP) that is defined as optic degeneration with a slowly progressive deterioration of the visual field that may lead to blindness. More than 1 million Americans are being treated for glaucoma, and 80,000 are legally blind as a result of the disease. Glaucoma has its highest prevalence among the elderly population, with an incidence of approximately 1% in those older than 60 years, 3% in those between the ages of 70 and 80 years, and more than 9% in those older than 80 years. Treatment is directed at lowering high ocular pressures. The initial treatment, in most cases topical therapy with a beta-adrenergic blocking agent, reduces the IOP to help preserve sight. But such topical agents may also have adverse systemic effects on cardiac, pulmonary, central nervous system (CNS), and endocrine functions.

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The Efficacy of Apraclonidine as an Adjunct to Timolol Therapy

Cited by 44 publications

References 22 publications

The One-Month Effects of Topical Betaxolol, Dorzolamide and Apraclonidine on Ocular Blood Flow Velocities in Patients with Newly Diagnosed Primary Open-Angle Glaucoma

The One-Month Effects of Topical Betaxolol, Dorzolamide and Apraclonidine on Ocular Blood Flow Velocities in Patients with Newly Diagnosed Primary Open-Angle Glaucoma

The Short-Term Effect of Adding Brimonidine 0.2% to Timolol Treatment in Patients with Open-Angle Glaucoma

β-Blocker–Induced Complications and the Patient With Glaucoma

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