[Use of brimonidine 0.2% in treatment of glaucoma or ocular hypertony after poorly tolerated beta-blocker treatment].

This study intended to evaluate the advantages of brimonidine tartrate 0.2% (Alphagan((R))), a selective alpha-2 receptor agonist, relaying a poorly tolerated beta-blocker treatment. Effectiveness, as assessed by intraocular pressure, local and general tolerance of the treatment, and the quality of life of the patients included in the study, was compared for these two eye drops. This multicenter and prospective study, performed by 450 ophthalmologists, included 807 adults presenting with glaucoma or ocular hypertony over 8 months. After a poorly tolerated beta-blocker treatment, which had started at least 6 months before, these patients received brimonidine over 8 weeks. At 3 successive visits, intraocular pressure, biomicroscopic examination results, and visual acuity were recorded. A quality-of-life questionnaire evaluating breathlessness, fatigue, depressive mood, loss of appetite, and satisfaction with the treatment was also given to patients. In the 731 patients observed in the study, the analysis concluded a statistically significant decrease in intraocular pressure (-2.5mmHg) and in the cardiovascular parameters during brimonidine treatment: blood pressure was reduced by 3mmHg and 1.1mmHg for systolic and diastolic pressure, respectively. The heart rate rose by 1.7 beats/min. The quality-of-life questionnaire revealed less breathlessness (-26%), fatigue (-24.9%), depressive mood (-19.3%), and better appetite (+8.2%). The feeling of satisfaction with the brimonidine treatment was significantly improved for 95 patients. However, 12% of all patients stopped their treatment because of adverse effects. Brimonidine improved the glaucomatous patients' quality of life, at least in some areas. Improved intraocular pressure could at least in part result from better compliance with the treatment. Brimonidine is an encouraging alternative after an unsatisfactory beta-blocker treatment.