Apraclonidine versus brinzolamide-timolol combination to prevent intraocular pressure elevation after laser capsulotomy

AIM: To compare the efficacy of fixed combination of brinzolamide 1% and timolol 0.5%(FCBT)with apraclonidine 0.5%(APRA)in preventing intraocular pressure(IOP)elevations after neodymium: yttrium-aluminum-garnet(Nd:YAG)laser posterior capsulotomy.METHODS: This prospective randomized clinical study included 90 eyes of 90 consecutive patients who had Nd:YAG laser posterior capsulotomy for posterior capsule opacification(PCO). Patients were randomized to receive APRA(n=45)or FCBT(n=45)at 1h before laser surgery. A masked observer measured IOP by Goldmann applanation tonometry before the procedure and at 1, 2, 3, 24h and 7d after laser treatment. IOP outcome measures were grouped into the following categories: post laser IOP elevation of 5 to RESULTS:The mean IOP before surgery on the day of the procedure was 14.1±2.1 mm Hg in the APRA group and 13.2±2.1 mm Hg in the FCBT group. There was no statistically significant difference between the APRA and the FCBT groups of baseline IOPs measured(P=0.066). During the follow-up time, the mean IOP was lower in FCBT group, but this was not statistically significant. Six patients(13.3%)in APRA group and 4(8.9%)in FCBT group had IOP elevations of 5 to P=0.243). IOP elevations of 10 mm Hg or more occurred in 3 eyes(6.7%)in the APRA group and 1 eyes(2.2%)in the FCBT group; this was not statistically significant(P=0.542). CONCLUSION:Both of APRA and FCBT are effective for prevention and APRA is enough for most of routine cases. FCBT may be an option for the eyes those need more IOP reduction such as pre-existing glaucoma patients who are at higher risk for postoperative IOP elevations.