timolol, brimonidine, and latanoprost) to lower their IOP, which subsequently was changed to double maximum medical therapy (DMT, fixed drug combinations of tafluprost/timolol and brinzolamide/brimonidine). The rate of IOP change and adverse drug reactions were compared amongst the three age groups.RESULTS: The mean IOP change at three months after converting from TMT to DMT was −0.65 ± 1.42 mmHg (−3.84% ± 9.31%) among the overall study group, but this finding was not statistically significant (p = 0.108). In the 40 to 54 years and 55 to 69 years groups, the mean IOP change rates were +0.29 ± 0.96 mmHg (+2.40% ± 6.85%, p = 0.087) and −0.50 ± 0.99 mmHg (−3.05% ± 6.40%, p = 0.084) respectively. In the 70 years or older group, the mean IOP change, interestingly, was −1.80 ± 1.46 mmHg (−11.29% ± 9.31%, p < 0.001) and nine (47.4%) of the 19 subjects showed additional IOP reductions of 10% or more after converting from TMT to DMT. In all three age groups, the incidence rate of dry eye was significantly lower for DMT than for TMT (p = 0.031).CONCLUSIONS: In POAG patients, DMT was proven to be both effective and safe for lowering the IOP, especially in those 70 years or older group, when compared with the TMT protocol.]]>
Brimonidine Tartrate ; Disease Management ; Drug Combinations ; Drug-Related Side Effects and Adverse Reactions ; Glaucoma, Open-Angle ; Humans ; Incidence ; Intraocular Pressure ; Retrospective Studies

PURPOSE: To compare the allergy prevalence and clinical manifestations of 0.2% brimonidine/0.5% timolol fixed combination (BTFC) and 0.15% brimonidine in Korean patients with glaucoma. METHODS: We retrospectively analyzed the medical records of 196 glaucoma patients treated with BTFC and 234 glaucoma patients treated with 0.15% brimonidine. We compared sex, age, type of glaucoma, treatment period, allergy history, onset time of ocular allergy and clinical characteristics of allergy in the two groups. RESULTS: Ocular allergy percentages 10.14% in the BTFC group and 22.02% in the 0.15% brimonidine group, and the risk of allergy was approximately 0.4 times lower in patients using BTFC (hazard ratio = 2.5, p = 0.009). The BTFC group developed ocular allergy at a mean of 20.5 months (range: 1.7–51.1 months), and the 0.15% brimonidine group developed ocular allergy at a mean of 7.7 months (range: 0.4–50.8 months). In the BTFC group, 50% of the ocular allergy occurred within 15 months, and within 5 months in the 0.15% brimonidine group. Clinical characteristics of brimonidine allergy involved two types of conjunctival follicles and conjunctival papillae, but there were no significant differences in incidence according to allergy type (p = 0.566). CONCLUSIONS: The prevalence of ocular allergy in the BTFC group was lower than that in the 0.15% brimonidine group in Korean patients with glaucoma. The results of this study are expected to be useful for patient education and compliance improvement using brimonidine.
Brimonidine Tartrate ; Compliance ; Glaucoma ; Humans ; Hypersensitivity ; Incidence ; Medical Records ; Patient Education as Topic ; Prevalence ; Retrospective Studies ; Timolol

Administration, Oral ; Anti-Bacterial Agents ; administration & dosage ; Brimonidine Tartrate ; administration & dosage ; Diagnosis, Differential ; Doxycycline ; administration & dosage ; Face ; physiopathology ; Female ; Humans ; Inflammation ; Middle Aged ; Rosacea ; diagnosis ; drug therapy ; Singapore ; Steroids ; administration & dosage ; Treatment Outcome

PURPOSE: To evaluate the efficacy and safety of brinzolamide 1%/brimonidine 0.2% fixed combination (BBFC) in normal tension glaucoma (NTG) patients. METHODS: This prospective study included patients treated with brinzolamide 1% monotherapy, brimonidine 0.2% monotherapy or brinzolamide 1% and brimonidine 0.2% concomitant therapy, as well as newly diagnosed NTG patients. The enrolled patients who used brinzolamide 1% or brimonidine 0.2% switched to BBFC and newly diagnosed NTG patients were treated with BBFC. The patients receiving brinzolamide 1% or brimonidine 0.2% monotherapy or brinzolamide 1% and brimonidine 0.2% concomitant therapy switched antiglaucoma drugs to BBFC. Newly diagnosed NTG patients used BBFC as the first therapy. The study consisted of 1 screening/baseline visit and 3 follow-up visits conducted after 1, 4, 8, 12 and 24 weeks of treatment. Intraocular pressure (IOP), mean deviation value and adverse drug reactions were evaluated before treatment and after treatment with BBFC. RESULTS: The mean IOP in the brinzolamide 1% monotherapy group was 13.5 ± 1.6 mm Hg and the mean IOP after switched from brinzolamide 1% monotherapy to BBFC was 12.1 ± 1.5 mm Hg. The mean IOP in the brimonidine 0.2% monotherapy group was 14.2 ± 1.3 mm Hg and the mean IOP after switched from brimonidine 0.2% monotherapy to BBFC was 11.7 ± 1.5 mm Hg. The mean IOP was 11.9 ± 2.1 mm Hg in the brinzolamide 1% and brimonidine 0.2% concomitant therapy group and the mean IOP after switched from brinzolamide 1% and brimonidine 0.2% concomitant therapy to BBFC was 12.0 ± 1.1 mm Hg. The mean IOP and reduction rate were 10.7 ± 2.1 mm Hg and 35.5%, respectively,in the newly diagnosed NTG patients treated with BBFC. There was no serious adverse drug reaction causing ocular damage. CONCLUSIONS: BBFC provides a significant IOP reduction and is a safe antiglaucoma medication for NTG patients.
Brimonidine Tartrate ; Drug-Related Side Effects and Adverse Reactions ; Follow-Up Studies ; Humans ; Intraocular Pressure ; Low Tension Glaucoma* ; Prospective Studies

PURPOSE: To evaluate the neuroprotective effects of betaxolol (betaxolol hydrochloride) under hypoxic conditions using retinal ganglion cells (RGC-5) and determine whether heme oxygenase-1 (HO-1) expression exerts cytoprotective effects. METHODS: In this study, cultured RGC-5 cells were incubated with different concentrations of betaxolol hydrochloride (0.1 microM, 1 microM or 5 microM) and with 10 microM zinc protoporphyrin (ZnPP), in a hypoxia incubator (1% O2, 5% CO2, 94% N2) for 48 hours and the cell viability of each group was determined. Additionally, cell viability was measured after RGC-5 cells were incubated with 5 microM of brinzolamide (Azopt(R)), brimonidine tartrate (Alphagan(R)) or travoprost (Travatan(R)). RGC-5 cells were divided into three groups and incubated under three different conditions, normoxia group (20% O2, 5% CO2), hypoxia group (1% O2, 5% CO2) and the group with 5 microM of Betoptic S(R) treated under hypoxic conditions (hypoxia, Betoptic S(R)). After incubation for 4, 8, 12 and 24 hours, HO-1 expression was analyzed using Western blotting. RESULTS: Cell viability significantly increased in RGC-5 cells treated with Betoptic S(R) compared with other antiglaucoma agents. Increased levels of HO-1 expression indicate its relevance in cell viability. Furthermore, increased RGC-5 cell viability by Betoptic S(R) was significantly reduced in the HO-1 inhibitor ZnPP-treated group. CONCLUSIONS: We reaffirmed the known cytoprotective effects of Betoptic S(R) and the results suggests that HO-1 expression exerts cytoprotective effects against hypoxia.
Anoxia ; Betaxolol* ; Blotting, Western ; Cell Survival ; Heme Oxygenase-1* ; Heme* ; Incubators ; Neuroprotective Agents* ; Retinal Ganglion Cells ; Zinc ; Brimonidine Tartrate ; Travoprost

PURPOSE: To investigate the effects of bimatoprost on the permeability of cultured human trabecular meshwork cells (HTMC) monolayer. METHODS: HTMCs were cultured until confluency in the inner Transwell chamber and then exposed to benzalkonium chloride, brimonidine, latanoprost or bimatoprost for 1 week. Carboxyfluorescein permeability through the HTMC monolayer was measured using a spectrofluorometer after 2 hours in the outer chamber. Cellular viability was assessed using the MTT assay. RESULTS: Each drug diluted at 1/1000X did not affect the cellular survival (p > 0.05). Brimonidine, latanoprost and bimatoprost did not affect the carboxyfluorescein permeability through the HTMC monolayer (p > 0.05). The carboxyfluorescein permeability was not different between latanoptost and bimatoprost after 1 week of exposure (p > 0.05). CONCLUSIONS: Bimatoprost, a drug known to increase trabecular outflow, does not affect the carboxyfluorescein permeability through the HTMC monolayer. Thus, the effect on the trabecular outflow of bimatoprost may not be significant.
Benzalkonium Compounds ; Humans ; Permeability* ; Trabecular Meshwork* ; Bimatoprost ; Brimonidine Tartrate

We report five cases of non-arteritic anterior ischaemic optic neuropathy (NA-AION) where spontaneous resolution of the optic disc swelling occurred, and all relevant visual modalities were normal at presentation and remained so until resolution of the process after a median time of 9.6 weeks. This condition, which can be termed 'incipient NA‑AION' or 'threatened NA-AION', should be recognised so that unnecessary investigations for other and more serious causes of optic disc swelling can be prevented.
Adrenergic alpha-2 Receptor Agonists ; therapeutic use ; Adult ; Brimonidine Tartrate ; therapeutic use ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Ophthalmic Solutions ; Optic Disk ; pathology ; Optic Neuropathy, Ischemic ; diagnosis ; Singapore ; Time Factors ; Vision, Ocular ; Visual Acuity

PURPOSE: To examine retinal nerve fiber layer (RNFL) changes after intravitreal injection of bevacizumab in patients with or without underlying glaucoma. METHODS: A total of 104 eyes of 104 patients with retinal disease undergoing intravitreal injection of bevacizumab were prospectively investigated. Bevacizumab injections (1.25/0.05 mg/mL) were performed using a standardized technique. In the patient who had pretreatment with intraocular pressure (IOP)-lowering medication, 1 drop of brimonidine was instilled 30 minutes before the injection. Before and after the intravitreal injections, the patients were monitored for IOP and evaluated with optical coherence tomography using Stratus at least 3 months after the injection. RESULTS: Thirty minutes after injection, 6.4% of patients had an IOP over 30 mm Hg in the non-pretreatment group while no patient had an IOP over 30 mm Hg in the pretreatment group. In eyes with only retinal diseases, the RNFL thickness did not change significantly after the injection regardless of pretreatment, whereas in eyes with underlying glaucomatous damage and no pretreatment, significant decrease in RNFL thickness was observed at the superior (p = 0.036) and temporal (p = 0.048) sectors of the optic nerve head without pretreatment. CONCLUSIONS: Intravitreal injection of bevacizumab did not typically cause significant changes in RNFL thickness; however, in eyes with underlying glaucoma without pretreatment, a significant decrease in RNFL thickness was observed in the superior and temporal sectors of the optic nerve head. Therefore, applying IOP-lowering pretreatment medication before intravitreal injection of bevacizumab is required for protection of RNFL in glaucoma patients.
Glaucoma* ; Humans ; Intraocular Pressure ; Intravitreal Injections* ; Nerve Fibers* ; Optic Disk ; Prospective Studies ; Retinal Diseases ; Retinaldehyde* ; Tomography, Optical Coherence ; Bevacizumab ; Brimonidine Tartrate

PURPOSE: To examine retinal nerve fiber layer (RNFL) changes after intravitreal injection of bevacizumab in patients with or without underlying glaucoma. METHODS: A total of 104 eyes of 104 patients with retinal disease undergoing intravitreal injection of bevacizumab were prospectively investigated. Bevacizumab injections (1.25/0.05 mg/mL) were performed using a standardized technique. In the patient who had pretreatment with intraocular pressure (IOP)-lowering medication, 1 drop of brimonidine was instilled 30 minutes before the injection. Before and after the intravitreal injections, the patients were monitored for IOP and evaluated with optical coherence tomography using Stratus at least 3 months after the injection. RESULTS: Thirty minutes after injection, 6.4% of patients had an IOP over 30 mm Hg in the non-pretreatment group while no patient had an IOP over 30 mm Hg in the pretreatment group. In eyes with only retinal diseases, the RNFL thickness did not change significantly after the injection regardless of pretreatment, whereas in eyes with underlying glaucomatous damage and no pretreatment, significant decrease in RNFL thickness was observed at the superior (p = 0.036) and temporal (p = 0.048) sectors of the optic nerve head without pretreatment. CONCLUSIONS: Intravitreal injection of bevacizumab did not typically cause significant changes in RNFL thickness; however, in eyes with underlying glaucoma without pretreatment, a significant decrease in RNFL thickness was observed in the superior and temporal sectors of the optic nerve head. Therefore, applying IOP-lowering pretreatment medication before intravitreal injection of bevacizumab is required for protection of RNFL in glaucoma patients.
Glaucoma* ; Humans ; Intraocular Pressure ; Intravitreal Injections* ; Nerve Fibers* ; Optic Disk ; Prospective Studies ; Retinal Diseases ; Retinaldehyde* ; Tomography, Optical Coherence ; Bevacizumab ; Brimonidine Tartrate

PURPOSE: To report a single case of herpes simplex keratitis after application of 0.015% tafluprost eye drops. CASE SUMMARY: A 68-year-old male presented with left eye discomfort, epiphora, decreased visual acuity and hyperemia. The patient was diagnosed with glaucoma 6 weeks prior and started on 0.015% tafluprost eye drops in left eye and 0.15% brimonidine in both eyes. On slit lamp examination dendritic epithelial defect was observed and the patient was diagnosed with herpes simplex keratitis. The 0.015% tafluprost treatment was discontinued and 0.15% brimonidine was applied in both eyes twice a day. The herpetic keratitis in his left eye resolved completely in 2 weeks with acyclovir ointment and oral antiviral agent. No further recurrence was observed in the following 3 months.
Acyclovir ; Aged ; Glaucoma ; Humans ; Hyperemia ; Keratitis* ; Keratitis, Herpetic ; Lacrimal Apparatus Diseases ; Male ; Ophthalmic Solutions* ; Recurrence ; Visual Acuity ; Brimonidine Tartrate