Prophylaxi for econd Eye Involvement in Leber Hereditary Optic Neuropathy: An Open-Labeled, Nonrandomized Multicenter Trial of Topical Brimonidine Purite

Purpoe To tet a topical agent with purported antiapoptotic propertie a prophylactic treatment after firt eye involvement in Leber hereditary optic neuropathy (LHON), a maternally-inherited diorder characterized by bilateral, often equential, viual lo. Deign Open labeled, nonrandomized propective pilot tudy. Method Nine primary mutation molecularly confirmed LHON patient with one eye viion lo for le than 6 month and normal viual function in the fellow eye were treated with brimonidine purite 0.15% (Alphagan P) 4 time daily in the unaffected eye for up to 2 year. Viual acuity wa the primary efficacy outcome. econdary meaure included change on automated perimetry and quantification of the relative afferent pupillary defect. Reult There were 8 men and 1 woman enrolled, aged 13 to 54 year (mean 32 year), eight with the 11778 mitochondrial DNA (mtDNA) mutation, and one with the 3460 mutation. Depite normal viual acuity at baeline in all patient, 7 patient had ome minimal change in the central viual field of the tudy eye. All patient had deterioration of viion in their econd eye. In 1 of the 2 patient who had treatment initiated within 16 day after firt eye involvement, good viual acuity wa maintained in the tudy eye at 15 month followup, depite a mildly abnormal tudy eye baeline viual field. Concluion LHON may be a bilateral condition at onet more frequently than appreciated, with aymmetric everity at preentation. Topical brimonidine purite in thi doage wa unucceful in preventing econd eye involvement in recently monocularly-ymptomatic LHON.