Clinical Experience With the Long-term Use of 1% Apraclonidine

OBJECTIVE: To identify the incidence and characteristics of allergic reactions associated with the long-term use of 1% apraclonidine hydrochloride. METHODS: We undertook a retrospective analysis of 64 patients receiving long-term 1% apraclonidine therapy at the University of California-San Francisco Glaucoma Service. Patients were excluded if the duration of treatment was less than 2 weeks. Demographic data, initial intraocular pressure response, and incidence and characteristics of allergic reactions were obtained through chart review. Student's t test and chi 2 analysis were used to analyze the demographic data, and Kaplan-Meier survival analysis was used to estimate the long-term incidence of local reactions. RESULTS: Sixty-four patients met the criteria for the study. Of these, 31 (48%) developed an allergic reaction (responders) that led to discontinuation of treatment with the medication, with a mean latency of 4.7 months. Mean follow-up was 13.3 months. Patients free of local reactions (nonresponders) for at least 10 months were able to successfully continue apraclonidine use. Responders tended to be older and female. CONCLUSIONS: Our data are specific for the 1% preparation; however, physicians prescribing apraclonidine on a long-term basis should be aware of possible allergic reactions. A substantial percentage of patients developed this side effect, but most tolerated the medication for up to 4 months, and those without a local reaction after 10 months appeared to be able to continue apraclonidine use indefinitely. This allergic reaction is likely related to the adrenergic agent itself, and not to preservatives.