The potential of ??2-adrenergic agonists in the medical treatment of glaucoma

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Abstract
Alpha2-adrenergic agonists, such as clonidine, apraclonidine, and brimonidine, are effective ocular hypotensive agents. They effectively inhibit the rise in intraocular pressure after anterior segment laser procedures. Compared with clonidine, apraclonidine has fewer systemic side effects. Recently, it was approved for short-term use in glaucoma patients whose conditions remain uncontrolled on maximally tolerated medical therapy. Apraclonidine seems to be as effective as nonselective β-adrenergic antagonists in reducing intraocular pressure. As an adjunctive agent with β-blockers, it is more effective than dipivefrin. Fifteen percent to 35% of patients on apraclonidine develop ocular allergies, usually occurring after 1 month of therapy. Apraclonidine reduces anterior segment ocular blood flow. Whereas β-blockers reduce aqueous flow only during the day, apraclonidine also reduces flow at night. Alpha2-adrenergic agonists represent a useful new class of agents for glaucoma therapy.

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