Use of Brimonidine 0.1% in conservative therapy of glaucoma

Relevance In conservative therapy for patients with glaucoma, prostaglandin analogues are the first-line drug. However, there are a number of conditions in which this group of drugs is unacceptable for use. α2-adrenergic agonists can be used as initial therapy [1–3]. This group includes Brimonidine with different concentrations of the active substance: 0.1; 0.15 and 0.2%. However, even against the background of using Brimonidine, patients note both local and systemic adverse effects. Local side effects include the development of hyperemia, follicular conjunctivitis, and granulomatous uveitis [4]. Systemic side effects include drowsiness, fatigue, headache, and instability of blood pressure. It was found that the frequency of development and severity of adverse effects directly depend on the concentration of the active substance in the drug: the higher it is, the more often adverse effects occur. It has been previously studied that the use of 0.1% Brimonidine provides the same hypotensive effect as drugs with a higher percentage of the substance, while the incidence of local and systemic side effects is much lower [5]. Objective To prove the hypotensive efficacy and safety of 0.1% Brimonidine in patients with uncompensated primary open-angle glaucoma. Material and methods A group of 60 patients (60 eyes) diagnosed with primary open-angle glaucoma were prescribed 0.1% Brimonidine. The first group of patients (30 people, 30 eyes) used the drug with a frequency of use 2 times a day as a starting monotherapy. The second group of patients (30 people, 30 eyes) used the prescribed therapy with a frequency of use 2 times a day as an additional third hypotensive drug. Evaluation of hypotensive efficacy was carried out by comparative analysis of the results of measuring corneal-compensated intraocular pressure at the first visit and 1 month after the prescription of drops. Evaluation of the safety of the drug was carried out based on the results of corneal staining with fluorescein, the severity of vascular injection of the conjunctiva, the values ​​of the OSDI questionnaire and the level of patient compliance. Results When using 0.1% Brimonidine as monotherapy, the level of intraocular pressure decreased by 26.3% from the initial values. When using the drug in combination with other antihypertensive agents, the level of intraocular pressure additionally decreased by 15.9%. Conclusion Brimonidine at a concentration of 0.1% is a safe and effective local hypotensive agent. Key words: glaucoma; brimonidine; intraocular pressure; antihypertensive therapy