Use of Brimonidine Before LASIK With Femtosecond Laser-created Flaps for the Correction of Myopia: A Contralateral Eye Study

Abstract

This study suggests that brimonidine tartrate 0.2% administered before intraLASIK provides a reduction in the incidence of subconjunctival hemorrhage, hyperemia, and photophobia without increasing flap complications.

Dilute Brimonidine to Improve Patient Comfort and Subconjunctival Hemorrhage After LASIK

“…It is believed that brimonidine can destabilize fl ap adherence by adversely affecting corneal reepithe- Dilute Brimonidine for LASIK Patients/Pasquali et al lialization and endothelial cell function (the latter disrupting the negative intrastromal corneal pressure gradient responsible for early fl ap adherence). 18 Some studies have found no increase in the risk of fl ap complications with use of brimonidine, 6,7 whereas other studies have reported an incidence of fl ap dislocation varying from 10% to 36%. 5,8 We did not encounter any frank fl ap dislocations in 120 eyes treated with dilute brimonidine.…”

“…In particular, we measured decreases in patient reported levels of discomfort, irritation, burning, pain, and itching, with symptom scores among control eyes nearly double those of the medicated eyes 1 hour after surgery. Previous studies 6,7 have focused on the reduction in subconjunctival hemorrhage but have not recognized this benefi t for patients. Our study is also different from previous studies in that only a fraction of the brimonidine dose (1/8) was required for the same dramatic reduction in the rate (93% vs 10%) and severity (average score of 1.6 vs 0.2) of subconjunctival hemorrhage (control vs brimonidine, respectively).…”

“…5 In the studies that followed, no randomized prospective evidence was found to suggest that brimonidine increased the enhancement rate at all. [6][7][8] We believe that a 3-month follow-up period is not suffi cient for evaluating enhancement rate when regression can occur over longer time periods. We reason that one drop of a dilute medication used once before surgery is unlikely to have an effect on healing after 3 months, so if there were a dichotomy between the groups it is likely we would have observed it by that time.…”

“…4 Although these hemorrhages are temporary and without signifi cant visual consequence, reducing or eliminating them provides a more positive patient experience, avoids undue negative psychological effects, and enhances aesthetic outcomes in the procedure with a signifi cant cosmetic component. Topical vasoconstrictors such as brimonidine, [5][6][7][8] apraclonidine, 9 phenylephrine, 10 or combined naphazoline/pheniramine eye drops 11 help reduce postoperative subconjunctival hemorrhage, injection, and hyperemia. However, the use of these medications has been avoided due to the possibility that they may increase the incidence of fl ap dislocations 8 and the frequency of surgical enhancements.…”

“…5 It remains controversial whether brimonidine increases the rate of fl ap dislocation; of two recent prospective contralateral eye studies investigating the use of brimonidine 0.2% before LASIK, one demonstrated no increase in fl ap dislocation and the other demonstrated a 10.4% increase in the rate of fl ap dislocation. 6,8 Another concern with the use of these medications is their effect on pupil size and shape, [12][13][14] which could potentially interfere with pupil tracking.…”