Exposure to topical apraclonidine in children with glaucoma

Abstract

Purpose: The topical alpha-2 adrenergic agonist, brimonidine, although effective at intraocular pressure (IOP) reduction in adults, is contraindicated in infants/small children due to severe systemic side effects. The topical alpha-2 adrenergic agonist apraclonidine, used for short-term IOP reduction in adults, and described for Horner's syndrome testing, has recently been reported to cause systemic side effects in children. We have used topical apraclonidine 0.5% to treat infants and small children with glaucoma undergoing angle surgery, and selected children needing additional IOP reduction. Here we evaluate the safety of topical apraclonidine 0.5% when used in children with glaucoma.

Methods: Retrospective chart review of sequential children with glaucoma, having angle surgery or examination under anesthesia at Duke Eye Center from 1995 to 2006, who received topical apraclonidine 0.5%. Demographic and glaucoma-related information were noted, including any reported side effects.

Results: In all, 115 eyes of 75 pediatric glaucoma patients received apraclonidine 0.5% drops, for a total 179 treatment sessions. Most sessions (91%, 162/179) occurred during and after angle surgery, primarily in children with congenital/infantile glaucoma (53%, 40/75). Median age at apraclonidine exposure was 5.3 months (range, 0.1 mo to 17 y). Median number of apraclonidine dose exposures was 15 (range, 4 to 5745); median number of concurrent glaucoma medications was 3. Nonthreatening side effects were noted in 8% (6/75) total children: topical allergy (2 children), lethargy (3 children), and decreased appetite (1 child).

Conclusions: In contrast to brimonidine, topical apraclonidine 0.5% can safely be administered for short-term treatment of most infants and children undergoing angle surgery for glaucoma, rarely producing systemic side effects.