Post-trabeculectomy topical bevacizumab preventing bleb failure: a preliminary study

Abstract

This study aims to evaluate the efficacy and safety of post-trabeculectomy topical bevacizumab, in preventing bleb failure. A total of 11 females and 12 males were enrolled for the study. After a complete ophthalmic evaluation, the patients underwent trabeculectomy. Full ophthalmic examination was done the next day, which included visual acuity, intraocular pressure (IOP), and bleb morphology. Next, two drops of bevacizumab [0.25mg (0.01ml)] were instilled over the wound area with a tuberculin (1ml) syringe. Pressure was applied at the medial canthus to prevent it from going into the lacrimal passage. Similar postoperative procedures were repeated at 1, 2, 3, and 4weeks. So in all, five instillations of bevacizumab were completed. Later, the patients were followed at 1-month interval for 6months. Target IOP was achieved in all eyes and was maintained during the study period of 6months without any anti-glaucoma medication. Average IOP before trabeculectomy was 27.27 ± 8.92mmHg, which decreased postoperatively to 8.77 ± 0.97mmHg at 3months and 9.27 ± 1.16mmHg at 6months. This drop in IOP was statistically significant on both occasions (p = 0.00). A nice low filtering bleb was formed after the surgery, and it remained the same during the study period. The other parameters like cup-to-disc ratio and visual field did not change during the 6months of study as expected because glaucoma is a slow progressive disease. Modulating the wound at multiple sites by bevacizumab (inflammation, proliferative, and remodeling stages) can lead to success of trabeculectomy.