Back
Year : 2015 | Volume : 3 | Issue : 3 | Page : 210 - 213  


Original Articles
Comparative study of brimonidine and timolol in treatment of glaucoma

Jagadish Chandrarao Narasaiah Lakkineni

Associate Professor, Department of Pharmacology, MNR Medical College, Sangareddy, India

 

Corresponding Author:

Dr. Jagadish Chandrarao Narasaiah Lakkineni

Email: jagadishl.151@gmail.com

Abstract:

Background: As population is affected with primary open angle Glaucoma is large. It is important to evaluate drugs which effectively control the intraocular pressure. These drugs must be financially cheaper, easily available and control the intraocular pressure effectively. Therefore we have planned in our study to know the effects of Brimonidine (alpha selective adrenergic agent) and Timolol (sympatholytic agent) on Glaucoma.

Objective: To compare brimonidine and timolol in treatment of glaucoma

Methods: A total of 100 patients of glaucoma were studied. They were divided into two groups. One group consisting of 50 patients received Timolol and the other group with same number received Brimonidine. They were followed for 6 months. Initially they were examined at 1st week, 2nd week and then every month till six month. The results were compared.

Results: We found that timolol eye drops effectively reduced intra ocular pressure (IOP) when compared to brimonidine eye drops. The mean average IOP between these two drugs was found to be 1.9 actually. Brimonidine eye drops in initial phases of the study showed more variation in reducing IOP when compared to timolol eye drops.

Conclusion: Timolol eye drops effectively reduced IOP in primary open angle glaucoma than Brimonidine when instilled twice daily.

Key words: Brimonidine, Timolol, Glaucoma

INTRODUCTION:

Eye is one of the sensory organs. Glaucoma is the condition where the intraocular pressure of the eyeball increases more than normal. Normal pressure is 16 to 23mm of hg. There are two main type of glaucoma. One is primary angle Glaucoma and second one is primary angle closure Glaucoma. Among these, primary open angle Glaucoma is one of the important eye disease which produces blindness all over the world with almost equal sex distribution. Primary open angle Glaucoma is defined as a chronic pressure optic neuropathy associated with elevated intraocular pressure and visual field defects. It effects above 0.4% of the population over the age of 40 years. Inheritance of primary open angle Glaucoma is multifactorial and polygenic with abnormal chromosomes1.

The medical treatment of primary open angle Glaucoma includes parasympathetic agents, sympathomimetic agents, alpha selective adrenergic agents, carbonic anhydrase

 

 

 

 

 

 

inhibitors, prostaglandin analogues, and docosanoids and hyper osmotic agents. As population is affected with primary open angle Glaucoma is large. It is important to evaluate drugs which effectively control the intraocular pressure. These drugs must be financially cheaper, easily available and control the intraocular pressure effectively. Therefore we have planned in our study to know the effects of Brimonidine (alpha selective adrenergic agent) and Timolol (sympatholytic agent) on Glaucoma.

As India is developing country with more poor patients who cannot afford costly eye drops, we undertook this study to compare the efficacy of Brimonidine and Timolol in the treatment of Primary open angle Glaucoma.

METHODS:

A total of 100 cases of primary open angle glaucoma were studied. The confirmation of the diagnosis was done by gonioscopy, slit lamp examination, fundus examination and perimetry.

Study material:

  1. Topical drops of Timolol maleate 0.5%
  2. Topical drops of Brimonidine Tartrate 0.2%
  3. Goldman and Applation Tonometer

Inclusion Criteria: Patients with following conditions were included in the study.

  1. Age: 30-70 years
  2. Sex: male and female
  3. Cases: Primary open angle glaucoma Patients with 26mmHg Pressure and above 22mm of Hg.
  4. Patients with no history of recent treatment.
  5. With or without past history of similar disease.

Exclusion Criteria: The patients with the following condition were excluded from the study.

  1. Patients with Bronchial Asthma and other lung disorders
  2. Patients with cardiac disorder
  3. Patients with closed angle glaucoma
  4. Patients on glucocorticoids
  5. Conjunctive diseases
  6. Post operative ophthalmic cases such as Cataract, Trabeculectomy, Iredectomy etc.
  7. Pregnancy cases and Lactating mothers.
  8. Patients with more than 26mm of IOP
  9. Patients with extensive infection
  10. Patients with history of HIV positive.
  11. Patients with history of ocular injuries.
  12. History of Tuberculosis and leprosy were excluded from the study.
  13. Patients who are wearing contact lenses.

Methods: At first, the Ethical committee approval was taken. The study was conducted for a period of two years at MNR Medical College. The study included 100 patients and their consent was taken and these patients were divided into two sub groups; Group A and Group B. Group A patients exclusively used Timolol maleate 0.5% topical eye drops. Group B Patients exclusively used brimonidine tatrate 0.2% topical eye drops.

Group A: This group included 50 patients, who exclusively used Timolol maleate 0.5% topical eye drops in their glaucomatous eyes. The initial mean average IOP of their group was 24.9mm hg. The intraocular pressure readings were taken in following intervals.

  1. First week after initial reading.
  2. Second week after initial reading followed by
  3. First month up to six months at monthly intervals

Group B: This group included 50 patients who exclusively used Brimonidine tatrate 0.2% topical eye drops in their glaucomatous eyes. The initial mean average IOP in this group is 24.8mm hg. The intraocular pressure readings were taken in following intervals.

  1. First week of initial reading
  2. Second week after initial reading followed by first month up to six months at monthly.

Results were tabulated. Comparision and significance were tested by paried students ‘T’ test and their ‘P’ value are calculated. Results were shown graphically also.

RESULTS:

Table 1: Age and sex distribution of respondents

AGE AND SEX

TIMOLOL

BRIMONIDINE

40-50

10(20%)

12(24%)

51-61

31(62%)

23(46%)

61-70

9(18%)

15(30%)

MALE

26(52%)

22(44%)

FEMALE

24(48%)

28(56%)

 

Group A: Out of 50 respondents 10 belongs to age group of 40-50 years (20%), 31 belong to age group of 51-60 years (62%), 9 belong to age group of 61-70 year (18%)

Group B: Out of 50 respondents 12 belongs to age group of 40-50 years (24%), 23 belong to age group of 51-60 years (46%), 18 belong to age group of 61-70 year (30%)

Group A: Out of 50 respondents 24 are females (48%) & 26 are males (52%)

Group B: Out of 50 respondents 22 are males (44%) & 28 are females (56%)

Table 2: Distribution of mean difference of intraocular pressure

Right eye

Left eye

Timolol

Brimonidine

Total

Rt eye

Lt eye

Rt eye

Lt eye

Rt eye

Lt eye

<8

<8

23

26

41

42

64

68

>8

>8

27

24

9

8

36

32

Total

50

50

50

50

100

100

 

Table 3: Response of 1st and 2nd week treatment of Timolol 0.5%

Mean

Itching

Dryness of mouth

Watering of eye

1st week

2nd Week

1st week

2nd Week

1st week

2nd Week

1st week

2nd Week

19.1

18.7

4%

2%

6%

4%

6%

4%

 

The reduction of IOP after administering a drug twice daily was by 5.8 mm of Hg in the first week. The reduction of IOP after administering a drug twice daily was by 6.2 mm of Hg in 2nd week.

 

 

Table 4: Response of 1st and 2nd Month treatment of Timolol 0.5%

Mean

Itching

Dryness of mouth

Watering of eye

1st Month

2nd Month

1st Month

2nd Month

1st Month

2nd Month

1st Month

2nd Month

18.5

17.6

2%

Nil

4%

2%

2%

nil

 

The reduction of intraocular pressure after administering a drug twice daily was by 6.4 mm of Hg in the first month. The reduction of intraocular pressure after administering a drug twice daily was by 4.3 mm of Hg in the second month.

Table 5: Response of 3rd and 4th Month treatment of Timolol 0.5%

Mean

Itching

Dryness of mouth

Watering of eye

3rd  Month

4th  Month

3rd  Month

4th  Month

3rd  Month

4th  Month

3rd  Month

4th  Month

17.3

16.8

Nil

Nil

Nil

Nil

Nil

Nil

 

The reduction of intraocular pressure after administering a drug twice daily was by 7.6 mm of Hg in the third month. The reduction of intraocular pressure after administering a drug twice daily was by 7.8mm of Hg in the fourth month.

Table 6: Response of 5th and 6th Month treatment of Timolol 0.5%

Mean

Itching

Dryness of mouth

Watering of eye

5th  Month

6th  Month

5th  Month

6th  Month

5th  Month

6th  Month

5th  Month

6th  Month

16.8

16.7

Nil

Nil

Nil

Nil

Nil

Nil

 

The reduction of intraocular pressure (IOP) after administering a drug twice daily was by 8.1 mm of Hg in the fifth month. The reduction of intraocular pressure after administering a drug twice daily was by 8.2 mm of Hg in the sixth month.

Table 7: Response of 1st and 2nd week treatment of Brimonidine 0.2%

Mean

Itching

Dryness of mouth

Watering of eye

1st week

2nd week

1st week

2nd week

1st week

2nd week

1st week

2nd week

19

18.1

4%

2%

8%

6%

Nil

Nil

 

The reduction of IOP was by 5.8 mm of Hg in the first week. And in the second week it was 6.7 mmHg.

Table 8: Response of 1st and 2nd month treatment of Brimonidine 0.2%

Mean

Itching

Dryness of mouth

Watering of eye

1st month

2nd month

1st month

2nd month

1st month

2nd month

1st month

2nd month

18.2

18.4

Nil

Nil

2%

Nil

Nil

Nil

 

The reduction in the IOP was by 6.6 mmHg in the 1st month and 6.4 mmHg in the second month.

Table 9: Response of 3rd and 4th month treatment of Brimonidine 0.2%

Mean

Itching

Dryness of mouth

Watering of eye

3rd month

4th  month

3rd month

4th  month

3rd month

4th  month

3rd month

4th  month

17.7

17.8

Nil

Nil

Nil

Nil

Nil

Nil

 

The reduction in the IOP was by 7.1 mmHg in the 1st month and 4 mmHg in the second month.

Table 10: Response of 5th and 6th month treatment of Brimonidine 0.2%

Mean

Itching

Dryness of mouth

Watering of eye

5th  month

6th  month

5th  month

6th  month

5th  month

6th  month

5th  month

6th  month

18.1

18.5

Nil

Nil

Nil

Nil

Nil

Nil

 

The reduction in the IOP was by 6.7 mmHg in the 1st month and 6.3 mmHg in the second month.

DISCUSSION:

Even though there were couple of studies under same topic, we have taken this topic again to confirm the previous studies and to reveal the effect of these drugs on coastal Andhra Pradesh people. This was not conducted earlier in this area. Another reason of taking this topic is that timolol eye drops are more cheaper and at the same time equally effective when compared with Brimonidine. This will definitely give less financial burden to glaucoma patients who are on medical treatment.

It is observed in our study that long standing effect of controlling intraocular pressure by Brimonidine is not superior when compared with timolol

Optic atrophy is not carried out by Brimonidine in long term usage with Timolol drops it is observed that intraocular pressure is maintained at constant level not only at the beginning but also after using for several months. Therefore Timolol eye drops are more effective in maintaining constant intraocular pressure, preventing visual field defects better and optic atrophy. In a long term study in (6 months) period, it is proved that Timolol is definitely better than Brimonidine eye drops in controlling intraocular pressure for prolonged period.

Timolol reduces intraocular pressure by membrane stabilization and decrease in diffusion of fluid at ciliary body at epithelium level. At present Timolol eyedrops are available in gel form which can be applied once in a day. Timolol eye drop are found to be reducing intraocular pressure 1.9 mm of Hg more than that of Brimonidine. (After long term follow up, the average is 1.9 mm Hg taken during the study period (6 months)).

Finally in the study it was found that Timolol 0.5% eye drops is more effective than Brimonidine 0.2% eye drops. Both drugs are effective, potent and well tolerated by patients. Nearly similar results were observed by (1) Kataz L.J, wills Eyes Hospital,2 Philadelphia, Pennsylvania 19107, USA,3 Sangos NT AHEPA Hospital, Aristotle4 University, Thesseloniki Greece,5 Davide R, Sam Rothberg Glaucoma Centre,6 Goldeshleger, Eye Institute, Change Sheba Medical Center, Tel Sahomer, Israel7 Albert and Jakobie8 Journal of pharmacy5 Society of Wisconisin may/20019 Archives of ophthalmology10

During following period of six months, adverse effects occurred in first bweek in descending order with both drugs. In first week in group A 4% of patients complained of mild itching, 6% complained of slight dryness of mouth and 6% of patients complained of slight watering of Eyes. No adverse effects were observed from third month onwards. In case of B group with brimonidine, 4% of patients suffered from itching, 8% of patients complained of dryness of month and no patient complained of watering of Eyes, in the descending order was observed. These results are similar with that of Allergen. Total cost of Timolol drugs is very than that of Brimonidine in six months duration.

CONCLUSION:

 

  1. Glaucoma is most important eye disease in the world. Research is going on to decrease this disease. Various drugs like batablockers, Carbonic enhydrase inhibitors, Alfa adrenergic and etc., are used tropically for the treatment of Glaucoma.
  2. The present study is to compare the efficacy of tropical timolol maleate with Brimonidine tartrate in the management of primary open angle glaucoma. The two drugs were studied in the two different groups (Group A & Group B) for the period of 6 months.
  3. In my six months study of comparison between Timolol mateate 0.5% eyedrops versus Brimonidine 0.2% eyedrops in glaucomatous eyes revealed that Timolol mateate 0.5% eyedrops effectively reduced Intraocularpressure (IOP) when compared with Brimonidine Tatrate eyedrops. The mean average Intraocular pressure (IOP) between these two drops in initial phases of study showed more variation in reducing intraocular pressure (IOP) when compared to Timolol Maleate 0.5% eye drops. ‘Paried t’ test value for Timolol = 27.03. ‘Paire t’ test value for Brimonidine= 30.31.
  4. It was concluded Timolol decrease the pressure 1.5 mm Hg more when compared with Brimonidine at the end of six months period.
  5. Timolol maleate eye drops effectively reduced intraocular pressure in primary open angle glaucoma eyes than Brimonidine 0.2% eyedrops when instilled twice daily.
  6. Adverse effects like itching, dryness of mouth were notice malaria with both Timolol & Brimonidine but watering of eyes was seen withTimolol.

REFERENCES:

 

  1. V. Neema; Nitin Neema; Glaucoma, Text book of Ophthalmology, 4th edition, 194 & 202.
  2. Katz LJ; wills Eye Hospital, Philadelphia, Pennsylvania 19107, USA.
  3. Albert & Jakobiec: John V. Thomas: Glaucoma Principles and practice of Ophthalmology. 2nd edition, Volume 4. Page No.. 2684.
  4. Slangos NT: AHEPA Hospital, Aristotle University, Thessaloniki, Greece.
  5. General of Pharmacy Society of Wisconsin May/June 2001:33
  6. David R; Sam Rothberg Glaomcoma center, Glodghleger Eye Institute, Chaim Sheba Medical center, Tel Hashomer, Israel.
  7. General of Pharmacy Society of Wisconsin May/ June 2001:34.
  8. Am J ophthalmol 2001 Jun:; 131 (6); 729-33
  9. Surv ophthalmaol 1996 No; 41 Suppl 1:527-37
  10. Archieves of Ophthalmology 2001; 119; 492-495






img

Important links

adv apply rec

Open Access Journal

MRIMS Journal of Health Sciences is an open access journal which means that all content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal without asking prior permission from the publisher of the author. This is in accordance with the BOAI definition of open access.

Visitor Count


539939
© 2020 Chandramma Education society . All Rights Reserved.