Exposure to topical apraclonidine in children with glaucoma

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.

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.

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).

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.