Control of Intraocular Pressure and Fluctuation With Fixed-Combination Brimonidine-Timolol Versus Brimonidine or Timolol Monotherapy

PURPOSE: To evaluate control of intraocular pressure (TOP) and IOP fluctuation in patients with ocular hypertension or glaucoma treated with fixed-combination brimonidine timolol compared with brimonidine or timolol monotherapy. DESIGN: Post hoc analysis of data from 2 identical, 12-month, randomized, double-masked, multicenter trials. METHODS: Patients were treated bilaterally with fixed brimonidine timolol twice a day (n = 385), brimonidine tartrate 0.2% 3 times a day (n = 382), or timolol 0.5% twice a day (n = 392). Diurnal TOP was measured at follow-up visits at weeks 2 and 6 and months 3, 6, 9, and 12. IOP fluctuation was defined as the standard deviation of TOP measurements. RESULTS: The percentage of patients with mean diurnal IOP <18 mm Hg and short-term (daily) TOP fluctuation mm Hg was statistically significantly higher in the brimonidine timolol group than in the brimonidine or timolol group at each follow-up visit (at month 12, brimonidine timolol 43.0%; brimonidine 18.9%, timolol 33.5%, P <= .017). At each hour (8 AM, 10 AM, 3 PM, and 5 PM), the percentage of patients with mean IOP <18 mm Hg and long-term (intervisit) IOP fluctuation mm Hg was statistically significantly higher with brimonidine timolol than with brimonidine or timolol alone (at 8 AM, brimonidine timolol 41.0%, brimonidine 11.3%, timolol 23.7%, P < .001). CONCLUSIONS: Patients treated with fixed-combination brimonidine-tirnolol were more likely than patients treated with either brimonidine or timolol alone to achieve a combination of low mean IOP and low short-term (daily) or long-term (intervisit) 1013 fluctuation. (Am J Ophthalmol 2011;151:93-99. (c) 2011 by Elsevier Inc. All rights reserved.)