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Dilute brimonidine reduces subconjunctival hemorrhage, improves comfort after LASIK
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Administration of dilute brimonidine before LASIK reduced subconjunctival hemorrhage and injection while improving patient comfort postoperatively, a study found.
The randomized, double-masked, prospective study included 360 eyes of 180 patients that underwent administration of topical dilute brimonidine or naphazoline/pheniramine in one eye per patient compared with a control in the fellow eye (Systane Ultra, Alcon) preceding LASIK.
Eyes treated with dilute brimonidine had significantly reduced outcomes of discomfort, subconjunctival hemorrhage and injection at 1 hour and 1 day postoperative evaluations.
Refloats were required for mild-flap edge wrinkling in three of the dilute brimondide eyes and one naphazoline/pheniramine eye with no cases in the control group. The difference was not statistically significant, the study authors said.
“These potential consequences are important to consider given that we are seeking to increase patient comfort and minimize the social and psychological impact of subconjunctival hemorrhage,” they said.
Disclosure: The study authors report no relevant financial disclosures.
Perspective
Back to TopNoel A. Alpins, MD
Topical vasoconstrictor and alpha-agonist brimonidine eye drops diluted to one-quarter strength (0.025%) were examined for their effect on postoperative symptoms of subconjunctival hemorrhage, injection and hyperemia commonly occurring in patients after femtosecond flap creation, using a 60 Hz IntraLase FS (Abbott Medical Optics). However, of the 120 eyes, flap-edge wrinkling requiring refloat occurred in three eyes in this prospective study compared to one naphazoline eye and no controls, demonstrating that the actual risk was not statistically significant. Re-treatments were relatively high, which were equivalent for all groups at 7.5% using Allegretto WaveLight laser, showing no advantage in this respect to the vasoconstrictor group in this double-blind, randomized study of 360 eyes.This well-constructed but underpowered study for the purpose demonstrated equivalent visual outcomes and significantly improved patient discomfort experienced postoperatively when constructing a femto flap but with likely greater risk to flap stability. The study confirms the existence of significant symptoms with laser flaps that are not often discussed.
Surgeons who employ effective bladed microkeratomes should consider brimonidine unnecessary as these comfort issues are rare. Inclusion of a microkeratome group might have been a useful addition to increase its relevance to all LASIK surgeons.
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