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2.
Jpn J Ophthalmol ; 63(4): 322-327, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31115761

RESUMO

PURPOSE: To compare the efficacy and safety of two combinations of maximum medical therapy for lowering intraocular pressure (IOP) in primary open angle glaucoma (POAG). STUDY DESIGN: A retrospective consecutive case series. METHODS: A retrospective consecutive case series study including 82 eyes of 82 subjects with POAG treated with maximum medical therapy to lower IOP. Enrolled patients were divided into 2 groups: the triple maximum medical therapy (TMT) group, comprising POAG patients who were treated with tafluprost, brimonidine and the fixed drug combination (FDC) brinzolamide/timolol; and the double maximum medical therapy (DMT) group, comprising POAG patients who were treated with the FDCs tafluprost/timolol and brinzolamide/brimonidine. We compared the demographics, baseline IOP, IOP reduction rate, and adverse drug reactions (ADRs) between the 2 groups. RESULTS: While the mean IOP reduction rate after 12 months was higher in the TMT group (52.7%) than in the DMT group (50.4%), the difference was not significant (p-value = 0.615). In the TMT group, the rate of proceeding to laser or surgical therapy was 22.2% (DMT group = 37.8%). In the TMT group, the time duration between beginning maximum medical therapy and proceeding to laser or surgical therapy was 10.7 ± 1.3 months (DMT group = 10.3 ± 1.5 months). No serious ADRs were reported in either group. However, the incidence rate of conjunctival hyperemia and dry eye was significantly lower in the DMT group than in the TMT group. CONCLUSION: DMT is safe and effective for lowering IOP in POAG patients. DMT is not inferior to TMT in POAG patients.


Assuntos
Tartarato de Brimonidina/administração & dosagem , Glaucoma de Ângulo Aberto/tratamento farmacológico , Pressão Intraocular/efeitos dos fármacos , Prostaglandinas F/administração & dosagem , Sulfonamidas/administração & dosagem , Tiazinas/administração & dosagem , Timolol/administração & dosagem , Idoso , Anti-Hipertensivos/administração & dosagem , Inibidores da Anidrase Carbônica/administração & dosagem , Relação Dose-Resposta a Droga , Combinação de Medicamentos , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
3.
Drug Deliv ; 26(1): 509-521, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31090464

RESUMO

Brimonidine tartrate (BRT) is a hydrophilic α2 adrenergic agonist used for the treatment of glaucoma. Glaucoma is an ocular disease affecting the anterior segment of the eye requiring lifetime treatment. Owing to the obstacles facing ocular delivery systems and hydrophilicity of BRT, frequent administration of the eye drops is required. Niosomes have been widely used to improve the ocular bioavailability of the topically applied drugs and to enhance the ocular residence time. However, they have drawbacks as physical instability, aggregation, and loss of the entrapped drug. For this reason, BRT proniosomes were prepared to overcome niosomal instability issues. A D-optimal design was utilized to determine the optimum conditions for preparation of the proniosomal gels. Independent variables were amount of surfactant, surfactant:cholesterol ratio, and type of surfactant used. The dependent variables were entrapment efficiency (EE%), particle size, percentage of drug released after 2 h (Q2h), and percentage of drug released after 24 h (Q24h). The optimum formula was suggested with desirability 0.732 and the composition of 540 mg Span 60 and 10:1 surfactant:cholesterol ratio. The results obtained after reconstitution were; EE% of 79.23 ± 1.12% particle size of 810.95 ± 16.758 nm, polydispersity index (PDI) 0.6785 ± 0.213, zeta potential 59.1 ± 0.99 mV, Q2h40.98 ± 1.29%, Q8h 63.35 ± 6.07%, and Q24h = 91.11 ± 1.76%. Transmission electron microscope imaging of the formula showed the typical spherical shape of niosomes. In-vivo pharmacodynamic study assured the improved ocular bioavailability of BRT selected formula when compared with Alphagan®P with relative AUC0-24 of 5.024 and 7.90 folds increase in the mean residence time (MRT). Lack of ocular irritation of the formula was assured by Draize test.


Assuntos
Tartarato de Brimonidina/administração & dosagem , Tartarato de Brimonidina/farmacologia , Sistemas de Liberação de Medicamentos/métodos , Olho/efeitos dos fármacos , Géis/química , Pressão Intraocular/efeitos dos fármacos , Animais , Tartarato de Brimonidina/toxicidade , Composição de Medicamentos , Olho/metabolismo , Glaucoma/tratamento farmacológico , Lipossomos , Masculino , Tamanho da Partícula , Coelhos , Propriedades de Superfície
5.
J Cosmet Dermatol ; 18(6): 1717-1720, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30924263

RESUMO

INTRODUCTION: Latanoprost is a prostaglandin F2α analogue, which has been used as a first-line drug for open-angle glaucoma. Common side effects of latanoprost include hyperpigmentation. While it usually occurs on irides or periocular skin, diffuse facial hyperpigmentation is rarely reported. CASE PRESENTATION: A 71-year-old woman was presented with diffuse gray-brown colored maculopatches on her face. The symptom appeared 1 week after she started to use latanoprost eye drops for glaucoma. Biopsy specimen revealed vacuolar degeneration of dermo-epidermal junction and pigment incontinence in dermis. OBJECTIVE: The aim of this paper is to introduce a rare adverse effect of latanoprost and effective way of treatment. METHODS: We stopped her from using latanoprost. She was also treated with 532-nm potassium titanyl phosphate laser and low-fluence 1064-nm Q-switched Nd:YAG laser, while using topical agents. RESULT: After 10 weeks, we observed hyperpigmentation of her face was effectively and safely treated. The patient was satisfied with the result. CONCLUSION: Diffuse facial pigmentation could be one of the latanoprost-induced adverse effects and the laser treatments with topical agents we used can make it improve faster.


Assuntos
Anti-Hipertensivos/efeitos adversos , Glaucoma/tratamento farmacológico , Hiperpigmentação/induzido quimicamente , Latanoprosta/efeitos adversos , Pigmentação da Pele/efeitos dos fármacos , Administração Cutânea , Administração Oftálmica , Idoso , Anti-Hipertensivos/administração & dosagem , Biópsia , Tartarato de Brimonidina/administração & dosagem , Fármacos Dermatológicos/administração & dosagem , Substituição de Medicamentos , Face , Feminino , Humanos , Hiperpigmentação/diagnóstico , Hiperpigmentação/patologia , Hiperpigmentação/terapia , Lasers de Estado Sólido/uso terapêutico , Latanoprosta/administração & dosagem , Terapia com Luz de Baixa Intensidade/instrumentação , Terapia com Luz de Baixa Intensidade/métodos , Soluções Oftálmicas/administração & dosagem , Soluções Oftálmicas/efeitos adversos , Pele/efeitos dos fármacos , Pele/patologia , Resultado do Tratamento
7.
J Cosmet Laser Ther ; 21(4): 225-227, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30235041

RESUMO

Postinflammatory hyperpigmentation (PIH) and erythema are the most common adverse effects associated with laser treatment, particularly in dark-skinned individuals. Several methods have been used to prevent or minimize these adverse effects; however, to date, no definitive precautions/strategies are known to prevent post-laser PIH and erythema. We investigated whether the topical application of the α-adrenergic receptor agonist brimonidine could reduce laser treatment-related complications such as erythema and PIH.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Tartarato de Brimonidina/administração & dosagem , Eritema/prevenção & controle , Hiperpigmentação/prevenção & controle , Terapia com Luz de Baixa Intensidade , Administração Tópica , Adolescente , Eritema/etiologia , Humanos , Hiperpigmentação/etiologia , Masculino , Pessoa de Meia-Idade , Tatuagem/efeitos adversos
9.
Diabetes ; 68(2): 457-463, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30389750

RESUMO

The primary objective of this study was to assess whether the topical administration of two neuroprotective drugs (brimonidine and somatostatin) could prevent or arrest retinal neurodysfunction in patients with type 2 diabetes. For this purpose, adults aged between 45 and 75 years with a diabetes duration ≥5 years and an Early Treatment of Diabetic Retinopathy Study (ETDRS) level of ≤35 were randomly assigned to one of three arms: placebo, somatostatin, or brimonidine. The primary outcome was the change in implicit time (IT) assessed by multifocal electroretinography between baseline and at the end of follow-up (96 weeks). There were 449 eligible patients allocated to brimonidine (n = 152), somatostatin (n = 145), or placebo (n = 152). When the primary end point was evaluated in the whole population, we did not find any neuroprotective effect of brimonidine or somatostatin. However, in the subset of patients (34.7%) with preexisting retinal neurodysfunction, IT worsened in the placebo group (P < 0.001) but remained unchanged in the brimonidine and somatostatin groups. In conclusion, the topical administration of the selected neuroprotective agents appears useful in preventing the worsening of preexisting retinal neurodysfunction. This finding points to screening retinal neurodysfunction as a critical issue to identify a subset of patients in whom neuroprotective treatment might be of benefit.


Assuntos
Retinopatia Diabética/tratamento farmacológico , Fármacos Neuroprotetores/administração & dosagem , Fármacos Neuroprotetores/uso terapêutico , Administração Tópica , Idoso , Tartarato de Brimonidina/administração & dosagem , Tartarato de Brimonidina/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Retinopatia Diabética/etiologia , Humanos , Pessoa de Meia-Idade , Somatostatina/administração & dosagem , Somatostatina/uso terapêutico
10.
Clin Exp Optom ; 102(2): 131-139, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30525235

RESUMO

BACKGROUND: The aim of this study was to provide an integrated analysis of safety and efficacy data for brimonidine tartrate ophthalmic solution 0.025 per cent (low-dose; Bausch & Lomb Incorporated), a topical vasoconstrictor for relief of ocular redness. METHODS: Integrated efficacy data from two randomised, double-masked, vehicle-controlled studies in subjects with ocular redness as well as safety data from the two efficacy studies, a vehicle-controlled safety study, and a pharmacokinetic study were analysed. Efficacy outcomes analysed included investigator-assessed ocular redness (scale, 0-4) before treatment instillation and at five to 240 minutes post-instillation on Day 1, at five minutes post-instillation on Days 15 and 29, and one week after treatment discontinuation (Day 36), and redness self-assessed by subjects recorded daily in diaries. Safety assessments included adverse events, ophthalmic examinations, and rebound redness upon treatment discontinuation. Drop comfort (scale, 0-10) was a tolerability measure. RESULTS: The efficacy population included 117 subjects (brimonidine, n = 78; vehicle, n = 39). The safety population included 635 subjects (brimonidine, n = 426; vehicle, n = 209). Investigator-assessed ocular redness was significantly lower with brimonidine versus vehicle at all post-instillation time points on Day 1 (mean change from pre-instillation of -1.4 units for brimonidine and -0.2 units for vehicle; p < 0.0001). Subject-assessed ocular redness was also significantly lower with brimonidine versus vehicle (mean treatment difference in average daily ratings of -0.9; p < 0.0001). There was no evidence of tachyphylaxis through Day 29 and rebound redness was rare. Incidence of ocular adverse events was low, the most common being reduced visual acuity (brimonidine, 4.0 per cent; vehicle, 4.3 per cent) and conjunctival hyperaemia (2.6 and 2.9 per cent, respectively). Both brimonidine and vehicle were rated as very comfortable (mean post-instillation scores, 0.4-0.5). CONCLUSION: In this integrated analysis, low-dose brimonidine significantly reduced ocular redness with no tachyphylaxis, and minimal rebound redness, and was generally safe and well tolerated.


Assuntos
Tartarato de Brimonidina/administração & dosagem , Túnica Conjuntiva/patologia , Conjuntivite/tratamento farmacológico , Adolescente , Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Agonistas de Receptores Adrenérgicos alfa 2/farmacocinética , Adulto , Idoso , Tartarato de Brimonidina/farmacocinética , Criança , Pré-Escolar , Túnica Conjuntiva/irrigação sanguínea , Túnica Conjuntiva/efeitos dos fármacos , Conjuntivite/metabolismo , Conjuntivite/patologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Instilação de Medicamentos , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas/administração & dosagem , Soluções Oftálmicas/farmacocinética , Resultado do Tratamento , Adulto Jovem
11.
J Med Case Rep ; 12(1): 349, 2018 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-30442199

RESUMO

BACKGROUND: Ibrutinib is a tyrosine kinase inhibitor commonly used in patients with chronic lymphocytic leukemia. Based on the published literature, it has a very sound ophthalmologic safety profile. In the following, we describe a case of anterior chamber fibrinoid syndrome in a patient on ibrutinib for B-cell chronic lymphocytic leukemia after uncomplicated cataract extraction. CASE PRESENTATION: A 75-year-old white man with B-cell chronic lymphocytic leukemia on ibrutinib therapy and without significant past ocular history presented 1 day after uncomplicated phacoemulsification with in-the-bag intraocular lens implantation with multiple, discrete, pigmented cords in the anterior chamber. His vision was 20/100 and intraocular pressure was 43 mmHg. There was no hypopyon, hyphema, or cellular reaction. The dilated fundus examination was unremarkable. He was diagnosed as having fibrinoid syndrome and started on topical prednisolone, brimonidine, timolol-dorzolamide, and orally administered acetazolamide. Within 2 weeks, the fibrin cords disappeared completely, vision improved to 20/30, and the intraocular pressure normalized off all medications. CONCLUSIONS: The precise etiology of fibrinoid syndrome remains unclear. This is the first case of fibrinoid syndrome in a patient on ibrutinib, which is known to cross the blood-brain barrier and induce intraocular changes. It is important to differentiate this syndrome from toxic anterior segment syndrome and endophthalmitis, and to initiate appropriate treatment. The fibrin bands tend to be exquisitely sensitive to topical steroids and to resolve within a few weeks without sequelae.


Assuntos
Câmara Anterior/patologia , Anti-Hipertensivos/administração & dosagem , Antineoplásicos/efeitos adversos , Extração de Catarata/efeitos adversos , Pressão Intraocular/efeitos dos fármacos , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Pirazóis/efeitos adversos , Pirimidinas/efeitos adversos , Administração Tópica , Idoso , Câmara Anterior/fisiopatologia , Antineoplásicos/administração & dosagem , Tartarato de Brimonidina/administração & dosagem , Humanos , Masculino , Facoemulsificação , Prednisolona/administração & dosagem , Pirazóis/administração & dosagem , Pirimidinas/administração & dosagem , Sulfonamidas/administração & dosagem , Síndrome , Tiofenos/administração & dosagem , Timolol/administração & dosagem , Resultado do Tratamento , Acuidade Visual
12.
Exp Dermatol ; 27(12): 1378-1387, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30290018

RESUMO

BACKGROUND: Rosacea is a chronic inflammatory skin disease. Characteristic vascular changes in rosacea skin include enlarged, dilated vessels of the upper dermis and blood flow increase. Brimonidine is approved for symptomatic relief of the erythema of rosacea. It acts by selectively binding to α2-adrenergic receptors present on smooth muscle in the peripheral vasculature, resulting in transient local vasoconstriction. OBJECTIVES: To provide further evidence of the anti-inflammatory potential of brimonidine across preclinical models of skin inflammation and its ability to decrease the neutrophil infiltration in human skin after ultraviolet light exposure. METHODS: The anti-inflammatory properties of brimonidine through modulation of the vascular barrier function were assessed using in vivo neurogenic vasodilation and acute inflammatory models and a well-described in vitro transmigration assay. A clinical study assessed the neutrophil infiltration in human skin after exposure to UV in 37 healthy Caucasian male subjects. RESULTS: In vitro, brimonidine affects the transmigration of human neutrophils through the endothelial barrier by modulating adhesion molecules. In vivo, in the mouse, topical treatment with brimonidine, used at a vasoconstrictive dose, confirmed its anti-inflammatory properties and prevented leucocyte recruitment (rolling and adhesion) mediated by endothelial cells. Topical pretreatment with brimonidine tartrate 0.33% gel once a day for 4 days significantly prevented neutrophil infiltration by 53.9% in human skin after exposure to UV light. CONCLUSION: Results from in vitro, in vivo and from a clinical study indicate that brimonidine impacts acute inflammation of the skin by interfering with neurogenic activation and/or recruitment of neutrophils.


Assuntos
Anti-Inflamatórios/administração & dosagem , Tartarato de Brimonidina/administração & dosagem , Rosácea/tratamento farmacológico , Pele/irrigação sanguínea , Pele/efeitos dos fármacos , Administração Cutânea , Adolescente , Adulto , Animais , Movimento Celular , Dermatite/tratamento farmacológico , Células Endoteliais/efeitos dos fármacos , Eritema/tratamento farmacológico , Células Endoteliais da Veia Umbilical Humana , Humanos , Inflamação , Masculino , Camundongos , Pessoa de Meia-Idade , Neutrófilos/citologia , Neutrófilos/efeitos dos fármacos , Proteoma , Raios Ultravioleta , Vasodilatação , Adulto Jovem
14.
Acta Biomater ; 79: 344-353, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30134206

RESUMO

We have proposed a metal-organic framework (MOF), NH2-MIL-88(Fe), as a novel carrier for topical drug delivery to the eye. The NH2-MIL-88(Fe) particles were prepared via a solvothermal synthesis method and their structure was confirmed by powder X-ray diffraction, Fourier transform infrared analysis, thermogravimetric analysis, electron microscopy, and N2 adsorption-desorption measurements. When brimonidine, an anti-glaucoma medicine, was encapsulated into NH2-MIL(Fe)-88 (i.e., NH2-MIL-88(Fe)/Br), the drug was loaded at 121.3 µg/mg and released in a sustained manner for up to 12 h. The NH2-MIL-88(Fe)/Br exhibited mucoadhesive properties and remained on rabbit eyes for a period of up to 4 h. Consequently, a high concentration of brimonidine was found in tears for a prolonged period after the administration of NH2-MIL-88(Fe)/Br, which resulted in a greater than two-fold increase in drug bioavailability and activity period compared with those of Alphagan P, which are brimonidine eye drops already approved for clinical use. Hence, NH2-MIL-88(Fe) is suggested to be a promising carrier for topical delivery to the eye that provides enhanced bioavailability of ocular drugs. STATEMENT OF SIGNIFICANCE: We suggest NH2-MIL(Fe)-88, a type of metal-organic frameworks (MOFs), as delivery carriers of an ophthalmic drug, brimonidine. The NH2-MIL(Fe)-88 particles possess a mucoadhesive property, hence prolonged retention in the preocular space when topically administered to the eye. The particles can also encapsulate the drug in their micro-pores, through which the drug can be released in a sustained manner. Therefore, when tested to rabbit eyes in vivo, the drug-loaded NH2-MIL(Fe)-88 particles were shown to enhance the ocular drug bioavailability, as compared with Alphagan P, the marketed eye drops of brimonidine.


Assuntos
Tartarato de Brimonidina/administração & dosagem , Tartarato de Brimonidina/farmacologia , Portadores de Fármacos/química , Sistemas de Liberação de Medicamentos , Estruturas Metalorgânicas/química , Soluções Oftálmicas/administração & dosagem , Soluções Oftálmicas/farmacologia , Adesividade , Animais , Humor Aquoso/efeitos dos fármacos , Morte Celular/efeitos dos fármacos , Humanos , Pressão Intraocular/efeitos dos fármacos , Muco/metabolismo , Coelhos
15.
Mol Pharm ; 15(8): 3143-3152, 2018 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-30020792

RESUMO

To treat glaucoma, conventional eye drops are often prescribed. However, the eye drops have limited effectiveness as a result of low drug bioavailability due to their rapid clearance from the preocular space. To resolve this, we proposed amino-functionalized mesoporous silica (AMS) particles as delivery carriers of the glaucoma drug, brimonidine. Because of the presence of mesopores, brimonidine (BMD) could be encapsulated in the AMS with a loading amount of 41.73 µg/mg (i.e., drug loading capacity of about 4.17%) to give the BMD-AMS, which could release the drug in a sustained manner over 8 h. BMD-AMS was also shown to be mucoadhesive due to the presence of both hydroxyl and amino groups in the surface, allowing for formation of hydrogen bonds and an ionic complex with the mucin, respectively. Therefore, when topically administered to rabbit eyes in vivo, BMD-AMS could reside in the preocular space for up to 12 h because of its adherence to the mucous layer. To assess in vivo efficacy, we examined the variance in intraocular pressure (IOP) and brimonidine concentration in the aqueous humor (AH) after applying BMD-AMS to the eye, which was compared with that induced by Alphagan P, the marketed brimonidine eye drops. For BMD-AMS, the duration in the decrease in IOP and the area under the drug concentration in the AH-time curve (AUC) were 12 h and 2.68 µg·h/mL, respectively, which were about twice as large as those obtained with Alphagan P; this finding indicated enhanced ocular bioavailability of brimonidine with BMD-AMS.


Assuntos
Anti-Hipertensivos/administração & dosagem , Tartarato de Brimonidina/administração & dosagem , Portadores de Fármacos/química , Glaucoma/tratamento farmacológico , Dióxido de Silício/química , Administração Oftálmica , Animais , Anti-Hipertensivos/farmacocinética , Anti-Hipertensivos/toxicidade , Humor Aquoso/efeitos dos fármacos , Humor Aquoso/metabolismo , Disponibilidade Biológica , Tartarato de Brimonidina/farmacocinética , Tartarato de Brimonidina/toxicidade , Portadores de Fármacos/toxicidade , Composição de Medicamentos/métodos , Liberação Controlada de Fármacos , Pressão Intraocular/efeitos dos fármacos , Masculino , Modelos Animais , Soluções Oftálmicas/administração & dosagem , Porosidade , Coelhos , Dióxido de Silício/toxicidade
16.
Dermatol Ther ; 31(5): e12657, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30028559

RESUMO

Brimonidine gel, originally approved for the treatment of facial rosacea, causes direct vasoconstriction and possesses extensive utilization in dermatologic fields. A Q-switched (QS) neodymium-doped yttrium aluminum garnet (Nd:YAG) laser is generally used to treat solar lentigo (SL), often leaving unwanted postinflammatory hyperpigmentation (PIH), especially in dark-skinned individuals. A 58-year-old man with Fitzpatrick skin type IV presented to remove solar lentigines from his face. Prior to and after laser treatment, topical brimonidine gel and steroid cream were applied. In this study, we investigated whether topical application of the α-adrenergic receptor agonist brimonidine could reduce PIH after QS laser treatment of lentigine in a dark-skinned patient.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Tartarato de Brimonidina/uso terapêutico , Dermatite/prevenção & controle , Hiperpigmentação/prevenção & controle , Lasers de Estado Sólido/efeitos adversos , Metilprednisolona/uso terapêutico , Administração Cutânea , Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Tartarato de Brimonidina/administração & dosagem , Dermatite/etiologia , Géis , Humanos , Hiperpigmentação/etiologia , Lentigo/cirurgia , Masculino , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade
17.
Lasers Surg Med ; 50(10): 1002-1009, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29911352

RESUMO

BACKGROUND: Laser and intense pulsed light (IPL) are standard symptomatic treatments for superficial telangiectasias, but postoperative erythema, oedema, and pain may prolong downtime. OBJECTIVES: To investigate whether topical brimonidine reduces IPL-induced inflammation in patients with moderate to severe facial telangiectasias. METHODS: A randomized, two-centre, single-blinded, split-face trial on adjuvant brimonidine and air-cooling versus air-cooling alone (control) in 19 patients treated in Denmark (n = 10 patients) and Belgium (n = 9). Brimonidine was applied to the allocated side after each of three facial IPL-treatments, given at 3-week intervals. Patients were assessed up to 1 month after the final treatment. Outcome measures included blinded clinical on-site evaluation of erythema and oedema (5-point-scales), objective erythema-scores (red-filter analysis), patient-evaluated pain (Visual Analogue Scale), IPL-efficacy (blinded photo-evaluation of telangiectasia clearance), and patient preference. RESULTS: In total, 19 patients were enrolled and completed the study. IPL induced moderate to severe erythema after each treatment. Application of brimonidine, reduced erythema to baseline values compared to air-cooling alone and sustained efficacy 24 hours after treatment (median difference reduction: score 1 at each assessment, P ≤ 0.022). Objective erythema-scores supported clinical findings, demonstrating a median erythema reduction of 50-95% after application of brimonidine and air-cooling compared to 9-28% reduction after air-cooling alone (P ≥ 0.002). No difference in reduction of IPL-induced oedema was observed between facial sides (P ≥ 0.227). Brimonidine and air-cooling slightly and consistently reduced postoperative pain compared to air-cooling alone (VAS 1.0 after brimonidine versus VAS 1.5-2.0 after air-cooling alone at treatment 1-3, P ≤ 0.032). At 1-month follow-up, patients experienced excellent clearance of telangiectasias (75-100% clearance) on both facial sides (P = 1.000). Patient preference supported clinical data and 79% of patients preferred brimonidine to control (P = 0.019). CONCLUSION: Compared to air-cooling alone, adjuvant brimonidine reduces IPL-induced erythema and associated pain while maintaining a high IPL-efficacy. Lasers Surg. Med. 50:1002-1009, 2018. © 2018 Wiley Periodicals, Inc.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Tartarato de Brimonidina/administração & dosagem , Edema/prevenção & controle , Eritema/prevenção & controle , Face , Terapia a Laser/métodos , Complicações Pós-Operatórias/prevenção & controle , Telangiectasia/cirurgia , Administração Tópica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Resultado do Tratamento
18.
Sci Rep ; 8(1): 9003, 2018 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-29899357

RESUMO

This study aimed to assess changes in pupil size, uncorrected visual acuity, refraction, and the direct and consensual light reflexes after instillation of brimonidine 0.1% in healthy subjects. The investigation comprised 46 eyes of 23 healthy subjects with no eye diseases in whom brimonidine 0.1% was instilled in the right eye. Pupil size was measured quantitatively under photopic and scotopic conditions, uncorrected visual acuity, refraction, and direct and consensual light reflexes before and at 1, 6, and 24 h after instillation. We found No significant change was found in refraction or uncorrected visual acuity (P = 0.999 and P = 0.998, respectively). A significant reduction in pupil size was observed under scotopic conditions at 1 h and 6 h after instillation (P = 0.007 and P = 0.005, respectively). The rate of pupil contraction and constriction speed measured by light reflexes were significantly increased at 1 h and 6 h after instillation (P = 0.021 and P = 0.033, respectively). Brimonidine 0.1% induced a significant reduction in pupil size under scotopic conditions without a significant change in refraction or visual acuity due to suppression of the sympathetic nervous system.


Assuntos
Tartarato de Brimonidina/farmacologia , Soluções Oftálmicas/farmacologia , Pupila/efeitos dos fármacos , Reflexo Pupilar/efeitos dos fármacos , Refração Ocular/efeitos dos fármacos , Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Agonistas de Receptores Adrenérgicos alfa 2/farmacologia , Adulto , Tartarato de Brimonidina/administração & dosagem , Feminino , Humanos , Masculino , Soluções Oftálmicas/administração & dosagem , Pupila/fisiologia , Reflexo Pupilar/fisiologia , Refração Ocular/fisiologia , Acuidade Visual/efeitos dos fármacos , Acuidade Visual/fisiologia
19.
J Glaucoma ; 27(7): 643-646, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29762267

RESUMO

PURPOSE: The purpose of this article was to study the intraocular pressure (IOP)-lowering effect of adding brimonidine as the fourth antiglaucoma medication to a preexisting therapy of 3 topical drugs. METHODS: This was a retrospective, register-based, cohort study of medical records and computerized medical information comprising 1 county in Sweden. The main outcome measure was change in IOP after brimonidine addition. Short-term and long-term effects were evaluated. RESULTS: Of 4910 patients on antiglaucoma medication, 69 (1.4%) initiated a treatment with brimonidine as the fourth drug during 2014. Fifty-three patients were eligible for analysis. Forty-six patients tolerated the treatment. Among them, short-term IOP decreased by 17% (confidence interval, 10%-25%; P<0.001) after a mean of 46 days (SD, 50 d). Twenty-eight patients, that is, 53% of the eligible, remained on unchanged therapy after a mean follow-up time of 368 days (SD, 61 d). The long-term mean IOP decrease in this group was 20% (confidence interval, 11%-29%; P<0.0001). An IOP reduction of at least 20% was reached by 28 and 14 patients, in the short-term and long-term follow-ups, respectively. CONCLUSIONS: Brimonidine has the potential to reduce the IOP significantly even when used as the fourth drug. In the short-term, half of the patients reached the target IOP reduction (≥20%). After 1 year, a quarter of the eligible patients had had a sustained, uneventful effect. Thus, brimonidine as the fourth adjunctive antiglaucoma drop seems a valuable option for a minority of patients.


Assuntos
Anti-Hipertensivos/administração & dosagem , Tartarato de Brimonidina/administração & dosagem , Glaucoma/prevenção & controle , Hipertensão Ocular/tratamento farmacológico , Soluções Oftálmicas/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Quimioterapia Combinada , Feminino , Glaucoma/epidemiologia , Humanos , Pressão Intraocular/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/epidemiologia , Hipertensão Ocular/fisiopatologia , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Suécia/epidemiologia , Tonometria Ocular
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