apraclonidine / Generic mfg. - LARVOL DELTA

Collaboration Between Emergency Medicine and Optometry Aids in Diagnosing Atypical Wallenberg Syndrome in a 37-Year-Old Female. (PubMed, J Binocul Vis Ocul Motil) - "This case report highlights an atypical clinical presentation featuring ipsilateral head, neck, shoulder, and eye pain with erythema, edema of the right eyelid and conjunctiva, alongside classic signs of dorsolateral medullary syndrome, also known as Wallenberg Syndrome, characterized by ipsilateral Horner's syndrome and contralateral loss of body pain and temperature in a 37-year-old female. The correct diagnosis of Wallenberg syndrome was achieved through the collaborative effort of eye care professionals, primary care, emergency, and neurology specialties in medicine."

Journal • Atherosclerosis • Cardiovascular • Dermatology • Infectious Disease • Pain

Pharmacologic Agents Used in the Assessment or Correction of Blepharoptosis: A Report by the American Academy of Ophthalmology. (PubMed, Ophthalmology) - "Phenylephrine, cocaine, hydroxyamphetamine, apraclonidine, naphazoline, and oxymetazoline can achieve short-term blepharoptosis correction. Phenylephrine, cocaine, and hydroxyamphetamine have been described only in the context of in-office evaluation of blepharoptosis or Horner syndrome, and their therapeutic role remains uncertain. Oxymetazoline hydrochloride ophthalmic solution 0.1% is the only medication approved by the United States Food and Drug Administration for treatment of acquired blepharoptosis in adults. Independent validation studies may be warranted for oxymetazoline hydrochloride and its long-term efficacy and safety data remain uncertain."

Journal • Dry Eye Disease • Keratitis • Ocular Inflammation • Ophthalmology • Pain • Xerostomia

DEW422-C001: A Double-Masked Comparison of FID 123320 Ophthalmic Solution to Vehicle for the Reduction of Ocular Redness (clinicaltrials.gov) - P3 | N=159 | Completed | Sponsor: Alcon Research | Active, not recruiting ➔ Completed

Trial completion • Ophthalmology

DEW422-C001: A Double-Masked Comparison of FID 123320 Ophthalmic Solution to Vehicle for the Reduction of Ocular Redness (clinicaltrials.gov) - P3 | N=159 | Active, not recruiting | Sponsor: Alcon Research | Recruiting ➔ Active, not recruiting | N=240 ➔ 159

Enrollment change • Enrollment closed • Ophthalmology

Differentiation of Horner Syndrome and Physiological Anisocoria by Automated Pupillometry. (PubMed, J Neuroophthalmol) - "Our results indicate that pupillometry is a robust tool to measure the dilation lag in Horner syndrome and, therefore, to distinguish pathological from physiological anisocoria obviating pharmacological testing. The high sensitivity of the test will allow to identify the patients with Horner syndrome requiring further investigation."

Journal • Ophthalmology

Investigation of the molecular interaction between apraclonidine, an α2-adrenergic receptor agonist, and bovine serum albumin using fluorescence and molecular docking techniques. (PubMed, Spectrochim Acta A Mol Biomol Spectrosc) - "Analysis of synchronous and 3-D fluorescence signals revealed microenvironmental variations close to BSA's Trp and Tyr residues upon APR addition. Both the competitive site marker as well as molecular docking results detected that APR exhibited a stronger binding affinity towards Drug Site 2 (DS2) compared to Drug Site 1 (DS1)."

Journal • Cardiovascular

DEW422-C001: A Double-Masked Comparison of FID 123320 Ophthalmic Solution to Vehicle for the Reduction of Ocular Redness (clinicaltrials.gov) - P3 | N=240 | Recruiting | Sponsor: Alcon Research | Not yet recruiting ➔ Recruiting

Enrollment open • Ophthalmology

Efficacy of Topical Apraclonidine for the Treatment of Ocular Synkinesis (clinicaltrials.gov) - P4 | N=0 | Withdrawn | Sponsor: University of Alabama at Birmingham | N=10 ➔ 0 | Not yet recruiting ➔ Withdrawn

Enrollment change • Trial withdrawal • CNS Disorders

A Double-Masked Comparison of FID 123320 Ophthalmic Solution to Vehicle for the Reduction of Ocular Redness (clinicaltrials.gov) - P3 | N=240 | Not yet recruiting | Sponsor: Alcon Research

New P3 trial • Ophthalmology

Efficacy of Topical Apraclonidine for the Treatment of Ocular Synkinesis (clinicaltrials.gov) - P4 | N=10 | Not yet recruiting | Sponsor: University of Alabama at Birmingham | Trial completion date: Nov 2025 ➔ Nov 2028 | Trial primary completion date: Nov 2024 ➔ Nov 2027

Trial completion date • Trial primary completion date • CNS Disorders

Are Alpha-2 Adrenergic Agonists Being Used in Infants? (AAO 2023) - "Purpose To evaluate the frequency of reported adverse events for brimonidine or apraclonidine in infants aged 24 months or less despite a well-known black box warning. Conclusion Despite well-known black box labels, alpha-2 agonists have still been used in infants, with systemic, life-threatening complications ensuing. Additional safeguards may be needed."

Glaucoma • Ophthalmology

16 Horner Syndrome: Can it be Familial? Case series in a family and review of literature. (PubMed, BMJ Open Ophthalmol) - "The anisocoria was more noticeable in the dark, Horner syndrome was confirmed with apraclonidine test.Case 2: Mother of case 1, 50-year-old female diagnosed with right Horner syndrome at the age of 14 in Austria...Our cases demonstrate that familial presentation could indicate an idiopathic aetiology as it is unlikely to have pathological Horner syndrome in two first degree relatives.Our case series highlights the importance of eliciting a family history of Horner syndrome and examining the family members. Positive family history can reassure patients while awaiting results of investigations."

Journal • Review • Mood Disorders • Ophthalmology • Pediatrics

A CASE OF HORNER SYNDROME AFTER PRONING IN A CRITICALLY ILL PATIENT WITH ACUTE RESPIRATORY DISTRESS SYNDROME (CHEST 2023) - "Patient was also noted to have new anisocoria with extreme pinpoint pupil of the right eye with no response to apraclonidine... Thoracic outlet syndrome must be considered as a possible cause of acute Horner syndrome in critically ill patients who undergo prone positioning for ARDS. Knowledge of this can help improve proning protocols to ensure patients are in the proper position."

Clinical • Acute Respiratory Distress Syndrome • Critical care • Infectious Disease • Influenza • Ophthalmology • Pneumonia • Pulmonary Disease • Respiratory Diseases • Septic Shock • Vascular Neurology

Hydroinsertion With A Twist (ESCRS 2023) - " The full glaucoma protocol consists of using a clear temporal corneal incision (to reduce disturbance to any pre-existing glaucoma filtration bleb, and to preserve superior conjunctiva in case drainage surgery is required at a later date); topical and intracameral anaesthesia and avoidance of high volume sub-Tenons or peribulbar local anaesthesia which can cause huge intraorbital and thus intraocular pressure rise; deploying dispersive instead of cohesive ophthalmic viscoelastic device (OVD) where possible; full removal of OVD including behind the IOL; topical anti-hypertensives such as Iopidine or Timolol providing no contraindication; and oral Acetazolamide for up to two days. In addition to a full glaucoma protocol to protect vulnerable glaucomatous eyes against pressure spikes and rises, the IOL hydro-insertion adds to safety as no OVD is left within the anterior chamber at the end of cataract surgery. Hydro-insertion has been used by the senior author and his team..."

Cataract • Glaucoma • Ophthalmology

Segmental Zoster Paresis Accompanied by Horner's Syndrome. (PubMed, Intern Med) - "The right pupil was dilated with instillation of 1% apraclonidine, indicating Horner's syndrome. The patient was treated with intravenous acyclovir and methylprednisolone. Focal weakness related to zoster, generally known as segmental zoster paresis, improved over five months, but Horner's syndrome remained. We suggest that aggressive intravenous treatment should be considered for rare cases of zoster that occur with a combination of these two neurological conditions."

Journal • Herpes Zoster • Infectious Disease • Varicella Zoster

Efficacy of Topical Apraclonidine for the Treatment of Ocular Synkinesis (clinicaltrials.gov) - P4 | N=10 | Not yet recruiting | Sponsor: University of Alabama at Birmingham | Trial completion date: Nov 2024 ➔ Nov 2025 | Trial primary completion date: Nov 2023 ➔ Nov 2024

Trial completion date • Trial primary completion date • CNS Disorders

Efficacy of apraclonidine eye drops in treating ptosis secondary to myasthenia gravis: A pilot clinical trial. (PubMed, Muscle Nerve) - P2 | "Apraclonidine may alleviate ptosis secondary to MG and may be an effective alternative treatment for this group of patients."

Journal • CNS Disorders • Myasthenia Gravis

When Not To Advise Post Concussion Active Recovery (ACSM 2023) - "She is taking sertraline and for one-week amitriptyline as well as propanol. • EKG: LVH, LBB ST deviation & T wave inversion• Bilateral carotid US: nl• Echocardiogram: LA moderately enlarged, LV severely enlarged EF of 30%, global longitudinal strain 27% • MRA & MRI Brain: nl• Cervical spine XR/MRI: decreased disc space height C5-C6 3 mm of retrolisthesis • Ice pack test: applied to eye with ptosis for 2 minutes improved at least 2 mm • Chest CT: groundglass opacities left lower lobe, enlarged mediastinal & bilateral hilar lymph nodes• US Elastography: No significant fibrosis, moderate hepatic steatosis• Labs: MUSK, LRP-4, AchR binding, AchR binding/blocking/modulating, TSH,CCP Ab, RF, ANA = neg• Sleep study: nl • Single fiber EMG: normalFINAL WORKING DIAGNOSIS: Seronegative Myasthenia Gravis; HFrEF, NICMP, non-compaction cardiomyopathy; unilateral ptosis; resting tremorTREATMENT AND OUTCOMES:Cardiac: single chamber ICD, sacubitril-valsartan, asa,..."

Cardiomyopathy • Cardiovascular • CNS Disorders • Fibrosis • Immunology • Movement Disorders • Myasthenia Gravis • Pain • Psychiatry • Pulmonary Disease

Practice Patterns in the Evaluation of Horner Syndrome (ARVO 2023) - "The adherence rate to the protocol was 26% and increased to 70.1% when apraclonidine testing was omitted...Layman Abstract (optional): Provide a 50-200 word description of your work that non-scientists can understand. Describe the big picture and the implications of your findings, not the study itself and the associated details."

Ophthalmology

Total Synthesis of Strempeliopidine and Non-Natural Stereoisomers through a Convergent Petasis Borono-Mannich Reaction. (PubMed, J Am Chem Soc) - "Our final synthetic sequence employs a diastereoselective Petasis borono-Mannich reaction to couple eburnamine to a trifluoroborate aspidospermidine derivative. These convergent approaches enabled the synthesis of eight diastereomers of this heterodimer and offer support for the reassignment of the absolute configuration of strempeliopidine."

Journal • Oncology

Horner’s syndrome: un underestimated complication (Euroanaesthesia 2023) - "Neuro-ophalmology confirmed the diagnosis of right sided HS with pharmacological testing using apraclonidine eye drops...HS remains a rare complication of IVJ catheterization² . According to most studies, the incidence in these contexts is 2-5%, but it seems to be underestimated Direct needle puncture of the cervical sympathetic fibers or compression of these structures by hematoma is the two most common mechanisms."

Anesthesia • Infectious Disease • Ophthalmology

Child Neurology: Horner Syndrome in an Otherwise Well-Appearing Infant. (PubMed, Neurology) - "In reviewing the patient's laboratory and imaging workup, we highlight key etiologic differences between the pediatric and adult populations. Other important teaching points included in the discussion are a review of sympathetic neuroanatomy and oculosympathetic paresis, the appropriate and evidence-based diagnostic workup in infants and children, and a review of pharmacologic testing using cocaine and apraclonidine drops."

Journal • Neuroblastoma • Oncology • Ophthalmology • Pediatrics • Solid Tumor

Effect of Apraclonidine on Eyelid Position and Use in Surgical Planning (COS 2022) - "This study investigates a novel use of apraclonidine eye drops in pre-operative assessment of ptosis repair. The results of this study show great accuracy in prediction of post-operative MRD1 values with use of apraclonidine 0.5% during the pre-operative assessment. These results suggest that apraclonidine may be useful for routine pre-operative assessment, allowing for accurate prediction of post-operative eyelid position following posterior approach ptosis repair and aiding in patient selection for this type of surgical repair."

Ophthalmology

Apraclonidine, an eye opener (EAN 2022) - "The eyelid elevating effect of apraclonidine eye drops was significantly more pronounced in eyes with a sympathetic denervation deficit compared to eyes with physiological anisocoria. Measuring the eyelid opening may therefore enhance the diagnostic accuracy of apraclonidine testing combined with pupillometry to differentiate Horner syndrome from physiological anisocoria."

Infectious Disease • Ophthalmology

Secondary angle closure glaucoma secondary to 360 degrees DALK-iris adherences by AS-OCT Imaging (EGS 2022) - " The left eye was treated with maximum topical treatment (latanoprost, timolol, dorzolamide, apraclonidine) and oral acetazolamide 250mg three times daily. Progressively, his IOP reduced and at this moment is well controlled on dorzolamide 2%/ timolol 0.5% twice daily... Angle closure glaucoma secondary to oedema of the DALK graft-iris junction with the subsequent development of iridocorneal adhesions have not been reported previously. Solid medical management and continuous examining by both anterior segment specialties is a preventive step towards severe optic nerve damage and an essential step before a surgical approach. Imaging of the anterior segment using AS-OCT software remains as a major confirmation tool as well as a monitoring device."

Cataract • Corneal Abrasion • Glaucoma • Ophthalmology