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Objective To determine whether brimonidine 0.2% can control intraocular pressure (IOP) spikes as well as apraclonidine 1.0% can in those patients undergoing argon laser trabeculoplasty (ALT). Design Prospective, randomized, double-masked, clinical trial. Participants A total of 56 eyes of 41 patients with open-angle glaucoma or ocular hypertension were entered in the study; 46 eyes of 41 patients were eventually used for the final analysis. Intervention Patients were randomized to receive either brimonidine 0.2% or apraclonidine 1.0% before and after 360° ALT. Both patient and physician were masked as to which agent each patient received. Main outcome measures Intraocular pressure measurements were recorded before surgery and at 1, 2, and 4 hours after surgery. The difference between the preoperative IOP (baseline) and the highest recorded postoperative IOP was recorded as the maximum IOP change. The mean of the maximum IOP change for each group was analyzed using a two-sample, one-tailed t test. Results The mean of the maximum IOP change in the brimonidine 0.2% group was −2.6 ± 3.6 mmHg, and the mean for the apraclonidine 1.0% group was −2.3 ± 3.7 mmHg ( P = 0.8). No patient had a pressure spike greater than 10 mmHg. Conclusions Brimonidine 0.2% appears to be as effective as apraclonidine 1.0% in preventing IOP spikes after argon laser trabeculoplasty.

To determine if pilocarpine 4% produces miosis when delivered via a spray, eleven eyes of ten patients undergoing a laser peripheral iridotomy for occludable angles were pretreated with one application of pilocarpine spray to closed eyelids. Standardized pupil photographs for pupil diameter measurements were taken before and thirty minutes after the spray. Contralateral eyes served as controls (9 eyes) All treated eyes achieved miosis. The mean pupil diameter in the treated group was 4.1+/-0.9 mm before the spray and 1.5+/-0.3 mm after the spray (p < 0.0001). The average change in pupil diameter in the treated group was 2.6+/-0.9 mm compared to 0.0+/-0.2 mm in the control eyes (p < 0.0001). Pilocarpine spray is an effective delivery modality for intraocular miosis.

One hundred eyes of 100 patients in whom Tenon's cysts (TCs) developed in the early postoperative period following trabeculectomy with mitomycin C were retrospectively studied to determine their incidence, possible risk factors associated with their development, and the clinical course of the patients in whom they occurred. The incidence of TC formation was 29/100 (29%). Significantly more cysts developed in the men than in the women. There were no significant differences between those patients in whom TCs developed and those in whom they did not in terms of age, race, type of preoperative medications, mean preoperative intraocular pressure (IOP), prior argon laser trabeculoplasty, prior trabeculectomy, prior Tenon's cyst formation, or prior cataract surgery. The 29 patients in whom a Tenon's cyst developed had a mean follow up of 22.0 ± 12.9 weeks, with a mean IOP at the last examination of 14.2 ± 6.3 mm Hg (as compared with 20.7 ± 8.3 mm Hg at the time of diagnosis). One patient required a repeat trabeculectomy with mitomycin C. Two patients required bleb needling, subsequent TC excision, and eventual seton placement. Of the remaining 26, 14 (54%) required no glaucoma medication for IOP control, 11 (42%) required one, and 1 (4%) required two.