Purpose: A trabeculectomy is frequently combined with extracapsular cataract surgery to minimize the risks of further optic nerve damage associated with intraocular pressure (IOP) elevations after cataract surgery in eyes with glaucoma. Acute IOP elevations still occur after this combined surgery. The author evaluated the efficacy of 1% topical apraclonidine, a relatively selective alpha 2 agonist, in minimizing this complication.
Methods: A prospective, randomized, double-masked study compared topical 1% apraclonidine with placebo. All eyes underwent otherwise uncomplicated combined trabeculectomy and extracapsular cataract surgery. They received the appropriate study drug before, immediately after, and 12 hours after surgery. Intraocular pressures were measured 24 hours and 1, 2, and 4 weeks after surgery.
Results: One hundred nine eyes (of 109 patients) underwent combined surgery. Fifty-nine received placebo. Preoperative mean IOPs were 22.5 +/- 4.2 mmHg for eyes treated with placebo and 24.0 +/- 7.7 mmHg for eyes treated with apraclonidine. Twenty-four hours after surgery, mean IOPs were 23.1 +/- 17.4 mmHg for placebo-treated eyes and 11.6 +/- 11.3 mmHg for apraclonidine-treated eyes (P < 0.001). Twenty-four hours after surgery, 12 (20%) placebo-treated eyes and 1 (2%) apraclonidine-treated eye had IOPs greater than 40 mmHg (P < 0.005).
Conclusion: Apraclonidine effectively decreased large IOP elevations in glaucomatous eyes undergoing trabeculectomy combined with extracapsular cataract surgery.