Bayer A. U.

MZT Oberland, Weilheim

Purpose: Intraocular pressure (IOP) spikes can occur in the immediate post-treatment period after YAG laser capsulotomy (YLC). The purpose of the current study was to evaluate long-term IOP after YLC and to compare the effectiveness of IOP control by apraclonidine and brimonidine.
Methods: 185 patients with bilateral phacoemulsification and IOL implantation with unilateral YLC were followed for a mean period of 28 months +/- 7.4 month. IOP readings were taken quarterly during follow-up.
Results: Of the 185 patients, 37 eyes with YLC required initiation of glaucoma medication during the follow-up period with only two eyes in the untreated group (p<0.0001). Target IOP was achieved in all 19 eyes by brimonidine whereas only 11 out of 18 eyes treated with apraclonidine showed good IOP control (p=0.002) with an onset of glaucoma in six eyes. There was no significant difference (p=0.134) between the two antiglaucoma agents in the treatment of IOP spikes in the immediate posttreatment period after YLC. Multiple regression analysis suggests that the IOP one hour after YLC was the only independent variable significantly associated with subsequent IOP elevation (p=0.0024). This suggests that preexisting decreased facility of outflow may be a preceding condition to subsequent persistent elevation in the IOP.
Conclusion: YLC can cause long-term and persistent increase in the IOP, resulting in new onset of glaucoma. Furthermore, brimonidine is more effective than apraclonidine in the control of IOP and the prevention of glaucomatous optic neuropathy.

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