brimonidine + brinzolamide (SJP0135 / Ailamide / SJP 0135)

Diluted brimonidine for improving early postoperative symptoms and subconjunctival hemorrhage after PRK and LASIK.

Napolitano Natália Fernandes Gonçalves NFG, Freitas Ana Vega Carreiro de AVC, Ribeiro Luís Gustavo de Imparato Rodrigues LGIR, Fairbanks Daniella Villas Boas DVB et al.

To assess whether low-concentration brimonidine (0.025%) improves early postoperative signs and symptoms following femtosecond laser-assisted in situ keratomileusis and photorefractive keratectomy without affecting pupil diameter or flap safety. This prospective, randomized, double-masked, contralateral-eye, single-center study was conducted between January and September 2024. In each patient, one eye received 0.025% brimonidine 15-30 min before surgery (mean: 21.3 ± 2.4 min), whereas the fellow eye received 0.15% sodium hyaluronate (control). Primary outcomes on postoperative Day 1 included subconjunctival hemorrhage laser-assisted in situ keratomileusis and patient-reported symptoms (0-10 scale; composite score). Pupil diameter was measured pre-ablation. Statistical analyses included McNemar and paired t tests, with a significant threshold of α=0.05. A total of 124 patients were included (54 laser-assisted in situ keratomileusis and 70 photorefractive keratectomy). Pupil diameter did not differ significantly between brimonidine-treated and control eyes (laser-assisted in situ keratomileusis: 2.63 ± 0.47 vs. 2.69 ± 0.42 mm, p=0.273; photorefractive keratectomy: 2.56 ± 0.44 vs. 2.61 ± 0.39 mm, p=0.116). In laser-assisted in situ keratomileusis, subconjunctival hemorrhage occurred less frequently in brimonidine-treated eyes both intraoperatively (9.3% vs. 46.3%, p<0.001) and on postoperative Day 1 (9.3% vs. 50.0%, p<0.001). Composite symptom scores were significantly lower in brimonidine-treated eyes in both laser-assisted in situ keratomileusis and photorefractive keratectomy groups (p=0.001 for both). Preoperative administration of low-concentration brimonidine (0.025%) significantly reduced subconjunctival hemorrhage in laser-assisted in situ keratomileusis without comprising flap integrity. It also improved early postoperative symptoms in laser-assisted in situ keratomileusis and photorefractive keratectomy, without affecting pupil diameter. These findings support the use of dilute brimonidine as a safe and effective adjunct to enhance the immediate postoperative experience in refractive surgery.

Multimodal imaging application of Sturge-Weber syndrome complicated with glaucoma: a case report of non-surgical treatment in a 7-year-old boy.

Tianyi Chen C, Yuxin Geng G, Danyan Liu L

To report the multimodal imaging characteristics and successful non-surgical intraocular pressure (IOP) control with bimatoprost in a 7-year-old boy with Sturge-Weber syndrome (SWS)-related glaucoma and diffuse choroidal hemangioma (DCH). Case report with multimodal imaging including ultra-widefield fluorescein angiography, indocyanine green angiography, B-scan ultrasound, ultrasound biomicroscopy (UBM), and cranial MRI. A 7-year-old boy with facial port-wine stain (V1 distribution) presented with right ocular distension and IOP of 36 mmHg. Multimodal imaging confirmed DCH, exudative retinal detachment, and open angle. Initial triple therapy (brinzolamide, brimonidine, carteolol) failed to lower IOP. After switching to bimatoprost monotherapy (once daily), IOP decreased to 18 mmHg within 4 weeks and remained stable at 3-month follow-up. No surgical intervention was required. In selected pediatric SWS patients with refractory glaucoma, bimatoprost may achieve excellent IOP control, avoiding surgical risks. Multimodal imaging is essential for accurate diagnosis and monitoring. This case challenges the traditional view that topical medications are ineffective in SWS-related glaucoma and highlights the potential of prostaglandin analogs as a first-line or early adjunctive therapy.

Severe metabolic acidosis with renal tubular acidosis features attributed to topical brinzolamide in a patient with stage 3 chronic kidney disease: a case report.

Chao Ming-Yuan Victor MV, Wang Yi-Chun YC

Metabolic acidosis is common in chronic kidney disease (CKD). However, when the severity of acidosis is disproportionate to renal dysfunction, exogenous causes must be excluded. Topical carbonic anhydrase inhibitors (CAIs) used for glaucoma are commonly perceived as locally acting; in patients with normal renal function their plasma free-drug concentrations are far below those required for systemic effects. In CKD, however, reduced clearance and reduced renal acid-excretory reserve can unmask systemic toxicity. Individual recognition of the syndrome remains uncommon at the bedside, particularly when it presents in the context of acute-on-chronic kidney injury, where its laboratory features can be obscured by acute kidney injury(AKI)-related acidosis. A 73-year-old Asian male with stage 3 CKD and glaucoma presented with progressive dyspnea, anorexia, and a 3-kg weight loss one month after starting fixed-combination brinzolamide 1% / timolol 0.5% eye drops. Laboratory evaluation revealed severe metabolic acidosis (pH 7.29; serum bicarbonate 8.9 mmol/L, from a pre-exposure baseline of 20.3 mmol/L) and acute-on-chronic kidney injury (creatinine 3.9 mg/dL versus baseline ~ 2.0 mg/dL). The disturbance was mixed: a delta-delta ratio of 0.42 (calculated using a reference normal serum bicarbonate of 24 mmol/L) indicated a substantial non-anion-gap (hyperchloremic) component superimposed on a smaller high-anion-gap component, with hypokalemia (K+ 3.3 mmol/L), hyperchloremia (Cl- 107 mmol/L), positive urine anion gap (+ 33.4 mmol/L), and a fractional excretion of bicarbonate of 4.3% measured during established acidosis (without bicarbonate loading). Other causes of metabolic acidosis were systematically excluded. Causality assessment by the Naranjo Adverse Drug Reaction Probability Scale yielded a score of 7 (probable). Discontinuation of the ophthalmic solution and alkali therapy resulted in the resolution of acidosis and recovery of renal function to baseline within one week, sustained at one-year follow-up. Topical CAIs can undergo significant systemic absorption, bypassing first-pass metabolism, and precipitate life-threatening acidosis in patients with reduced renal reserve. Clinicians must maintain a high index of suspicion for ophthalmic medications as hidden causes of mixed acid-base disorders in patients with CKD.

Correction to "Loss of Consciousness in a Child Following Accidental Ingestion of Brimonidine Ointment: A Case Report".

[This corrects the article DOI: 10.1002/ccr3.72901.].