The Effect of Brimonidine 0.15% on the Development of Bulbar Redness Following Femtosecond Laser Assisted Cataract Surgery

Purpose: To assess the effect of brimonidine tartrate 0.15% on reducing subconjunctival hemorrhage, measured with a bulbar redness score, following femtosecond laser assisted cataract surgery (FLACS). Patients and Methods: A prospective, masked randomized controlled study was done using single-blinded simple randomization. All FLACS cases completed between June and August 2019 were included except those on anticoagulation or with prior conjunctival surgery. All operated eyes received usual preoperative eye drops, while Study group received added brimonidine. Exclusion criteria included >1 vacuum attempt during FLACS and any intraoperative complications. All subjects received Bulbar Redness (BR) Score and Analyzed Area (AA) imaging by Oculus 5M Keratograph preoperatively and postoperatively. AA including non-conjunctival structures, 10% different from preoperative values were excluded from final analysis. Absolute values and differences between mean postoperative and preoperative BR and AA were compared using Student’s t-test. Results: 62 eyes (Study group=25, Control group=37) of 56 patients were randomized and included for analysis. Baseline demographic comparison between the two groups were similar. Preoperative BR score in the Study group trended higher (1.62) than Control (1.40, p=0.07), while postoperative BR score remained similar between groups (p=0.70). Difference in postoperative and preoperative BR score was significantly larger in the study group (-0.21±0.56) than controls (+0.06±0.43, p=0.036). Conclusions: The use of preoperative brimonidine in FLACS reduces the amount of postoperative subconjunctival hemorrhage following FLACS, as observed by reduced bulbar redness. Oculus 5M BR scoring has potential to be used as an objective method of quantifying subconjunctival hemorrhage after ophthalmic surgeries and procedures.