Effect of prophylactic brimonidine on bleeding complications and flap adherence after laser in situ keratomileusis

Several authors have assessed the effect of prophylactic briomonidine on bleeding complications and flap adherence after laser in situ keratomileusis (LASIK). This study further evaluates these potential associations.

We performed a prospective, double-masked, single-surgeon study of 31 patients (61 eyes) who underwent LASIK with or without prophylactic brimonidine for primary myopia/ myopic astigmatism (59 eyes) or hyperopic astigmatism (2 eyes). Among myopes, mean preoperative sphere was -4.44 +/- 2.21 D and mean cylinder was -1.04 +/- 1.01 D. Thirty-three eyes (54%) had nasal hinges; 28 eyes (46%) had superior hinges.

Subconjunctival hemorrhage was observed in 22 of 61 eyes (36.1%). Three of these 22 eyes (13.6%) received prophylactic brimonidine; the remaining 19 eyes with subconjunctival hemorrhage (86.3%) did not receive brimonidine (P < .0001). All but three eyes had some hyperemia; however, the amount of hyperemia was lower in the brimonidine group (P < .0001). Bleeding from the superior micropannus occurred in four of 61 eyes (6.6%). One of these four eyes received brimonidine. There was one case of flap slippage in a non-brimonidine eye with a nasal hinge; no flap striae were observed after repositioning.

This study suggests that brimonidine administered before LASIK may significantly reduce subconjunctival hemorrhage and reduce the amount of hyperemia.