To Compare the Effect of Fixed-Drug Combinations of Brimonidine+Timolol and Ripasudil+Timolol in Glaucoma

Background: Glaucoma is a chronic, progressive optic neuropathy and a leading
cause of irreversible blindness worldwide. Reduction of intraocular pressure (IOP)
remains the only proven strategy to slow disease progression. Fixed-drug
combinations are commonly used to enhance IOP control and improve treatment
adherence. While Brimonidine + Timolol is an established combination, comparative
data with newer combinations such as Ripasudil + Timolol, particularly in the Indian
population, remain limited.
Materials and Methods: This prospective, randomized, hospital-based
interventional study was conducted in the Department of Ophthalmology at a tertiary
care centre in North India. Ninety newly diagnosed patients with primary open-angle
glaucoma or normal-tension glaucoma were randomly allocated into two equal
groups. Group 1 received Brimonidine + Timolol, and Group 2 received Ripasudil +
Timolol. Intraocular pressure was assessed at baseline, 1 hour, 1 week, and 4 weeks
after advising drug for twice a day.. Safety and tolerability were evaluated during
follow-up. Statistical analysis was performed using Student’s t-test and chi-square
test, with p <0.05 considered statistically significant.
Results: Baseline demographic characteristics, clinical profile, and ocular
parameters were comparable between the two groups (p >0.05). Both fixed-drug
combinations produced a significant reduction in intraocular pressure following
initiation of therapy. Intraocular pressure reduction at 1 hour and 1 week was
comparable between the two groups (p >0.05). At 4 weeks, Group 2 demonstrated a
significantly greater reduction in intraocular pressure compared to Group 1 (p
<0.001). Both treatment regimens were well tolerated, with mild and self-limiting
adverse effects.
Conclusion: Both Brimonidine + Timolol and Ripasudil + Timolol are effective and
safe for short-term management of glaucoma. However, Ripasudil + Timolol
demonstrated superior for short-term intraocular pressure control.