Apraclonidine and Anterior Segment Laser Surgery: Comparison of 0.5% versus 1.0% Apraclonidine for Prevention of Postoperative Intraocular Pressure Rise

Purpose: To compare the efficacy of 0.5% and 1.0% apraclonidine in preventing laser-induced intraocular pressure (IOP) elevation after trabeculoplasty, neodymium: YAG (Nd:YAG) iridotomy, and capsulotomy. Methods: This is a prospective, masked, and randomized study of 83 patients undergoing trabeculoplasty, 62 patients undergoing iridotomy, and 57 patients undergoing capsulotomy. Surgical eyes received one drop of 0.5% or 1.0% apraclonidine immediately after surgery. Results: Intraocular pressure reduced 2 hours after trabeculoplasty in the 0.5% ( P = 0.028) and 1.0% ( P = 0.004) groups. Intraocular pressure was higher than baseline in a greater number of eyes treated with 0.5% (12 of 39 eyes, 31%) compared with 1.0% apraclonidine (5 of 44 eyes, 11 %) ( P = 0.032). Intraocular pressure in eyes with a narrow chamber angle was reduced in 16 (85%) of 19 eyes treated with 0.5% and in 10 (84%) of 12 eyes treated with 1.0% apraclonidine after iridotomy. Of patients with chronic angle-closure glaucoma, IOP was similar to prelaser values in 11 (69%) of 16 eyes treated with 0.5% ( P > 0.7) and 12 (80%) of 15 eyes treated with 1.0% apraclonidine ( P > 0.3). In patients undergoing capsulotomy, pressure was significantly lowered in the 0.5% group ( P = 0.04) but not in the 1.0% apraclonidine group. After capsulotomy, both treatment groups had similar ( P > 0.3) numbers of eyes with an IOP less than baseline (83% for 0.5% apraclonidine and 81% for 1.0% apraclonidine). Conclusion: The single postoperative administration of 0.5% apraclonidine is as effective as the 1.0% concentration in preventing IOP elevation immediately after trabeculoplasty, iridotomy, or capsulotomy.