Abstract
The present study aimed at observing the effect of a single subconjunctival injection of bevacizumab (BVZ) combined with 5-fluorouracil (5-Fu) or mitomycin C (MMC) on the antiscarring effect of glaucoma filtration surgery (GFS). The inhibitory effect of combined BVZ and 5-Fu in retinal pigment epithelial cells on vascular endothelial growth factor (VEGF) levels was demonstrated through in vitro experiments. Combined BVZ and 5-Fu and combined BVZ and MMC inhibited cell cycle, induced apoptosis, and inhibited human umbilical vein endothelial cell migration. Also, the cytotoxicity of combined BVZ and 5-Fu was lower. In animal experiments, the observation of filtering bleb survival, hematoxylin and eosin and Masson staining of filtering bleb scars, and mRNA expression levels of fibrosis markers in filtering blebs showed that combined BVZ and 5-Fu had a better antiscarring effect compared with single drugs; however, the antiscarring effect of combined BVZ and MMC was not significantly different from MMC. Therefore, the findings of this study provided more reference for the clinical use of adjuncts to inhibit scarring after GFS and helped understand the regulatory effect of combined anti-VEGF antibody BVZ and antimetabolites on wound healing more comprehensively.
Highlights
Glaucoma is a serious irreversible optic neuropathy that causes blindness
Kahook et al first reported and used the anti-vascular endothelial growth factor (VEGF) antibody as a potential wound-healing regulator; 1 mg BVZ was injected around a filtering bleb using a fine needle after MMC application failed [22]
Bevacizumab (Avastin), PhosSTOP, and protease inhibitors were purchased from Roche (Basel, Switzerland). e enzyme-linked immunosorbent assay (ELISA) kit was purchased from R&D Systems (MN, USA). e Bradford protein assay was purchased from Bio-Rad (Hercules, CA, USA)
Summary
Glaucoma is a serious irreversible optic neuropathy that causes blindness. In the 1990s, antimetabolic drugs, such as fluorouracil (5-Fu) and mitomycin (MMC), were used to reduce scar formation after a trabeculectomy and to maintain continuous unobstructed filtering, thereby improving the success rate of surgery [4]. Despite their effectiveness, these drugs were related to several types of life-threatening visual acuity complications [5, 6]. Kahook et al first reported and used the anti-VEGF antibody as a potential wound-healing regulator; 1 mg BVZ was injected around a filtering bleb using a fine needle after MMC application failed [22]. Cytotoxicity, the survival time of filtering blebs, and mRNA expression levels of fibrosis markers were observed. ese findings provided a reference for glaucoma treatment in clinical surgeries
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