Intracameral bevacizumab as an adjunct to trabeculectomy: A one year prospective, randomized study

Abstract

AbstractPurpose To investigate the efficacy and safety of a single intracameral administration of bevacizumab to improve the outcome of trabeculectomy.Methods Between April 2009 and November 2010, 144 consecutive, medically uncontrolled glaucoma patients who were scheduled for primary trabeculectomy were included in this prospective, randomized, double‐blinded and placebo‐controlled study. Patients were randomized to receive 50 µl of either bevacizumab (1.25 mg) or placebo (balanced salt solution) in the anterior chamber peroperatively. Normal tension glaucoma patients also received mitomycin C application. Absolute success was defined as intraocular pressure (IOP) ≤ 18 mmHg and > 5 mmHg with at least 30% reduction from baseline and no loss of light perception. The achievement of these criteria through the use of additional medical and/or surgical IOP‐lowering treatments was defined as qualified success.Results 138 patients completed a 12‐month follow‐up, 69 of whom had received a bevacizumab injection. IOP at 1 year postoperatively was significantly lower than baseline (placebo: 25.6±9.9 vs. 11.9±3.9, p<0.01; bevacizumab: 24.8±8.1 vs. 11.9±3.9, p<0.01), with no difference between bevacizumab‐ and placebo‐treated patients (p=0.69). However, absolute success was higher in the bevacizumab group (71% vs. 51%, p=0.02), with the number of IOP‐lowering interventions (needlings) being significantly lower in this group (13% vs. 36%, p=0.003). Complication rates were low and comparable in both groups.Conclusion Peroperative administration of intracameral bevacizumab significantly reduces the need for additional interventions during the follow‐up of patients undergoing trabeculectomy.