Topical vs Oral agents to lower intra-ocular pressure following cataract surgery (Acetazolamide vs Brimonidine)

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Tragically, one patient in this state recently suffered a fatal outcome following a severe allergic reaction to acetazolamide, a routine post-operative oral tablet used following cataract surgery to combat increases in the amount of fluid pressure within the operated eye. If not controlled, this increase in pressure can lead to damage to the optic nerve and retinal artery and vein occlusion in susceptible patients. There have been 2 similar cases of severe allergic reactions to acetazolamide reported in the medical literature. A survey of consultants in the United Kingdom found that 83% of surgeons who routinely prescribed pressure lowering medications used acetazolamide. We propose to investigate the use of brimonidine, a topical agent in a case-control study vs. oral acetazolamide in patients who have undergone phacoemulsification cataract surgery. We hypothesise that this topical agent will have a similar or superior efficacy in controlling ocular hypertension, whilst avoiding potentially serious systemic adverse effects. It is hoped that this may provide the impetus for change in clinical practice, where currently, the majority of patients are prescribed oral acetazolamide. To our knowledge, such a study comparing single dose use of these medications has not been published.

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