Subconjunctival bevacizumab as an adjuvant in first-time filtration surgery for patients with primary glaucomas

Abstract

To investigate subconjunctival bevacizumab as an adjuvant in first-time glaucoma filtration surgery, we conducted a non-comparative, interventional case series, enrolling consecutive patients with uncontrolled primary glaucomas. All patients underwent trabeculectomy with mitomycin C and received a 1.25mg subconjunctival bevacizumab injection at completion of the surgery. Main outcome measurements were success rates, bleb morphology [standardized classification based on vascularity (0-1), extension (0-1) and height (0-1); ranging from 0 to 3 (0=poor; 1=regular; 2=good; 3=excellent)] and post-operative complications. Twenty-five eyes from 25 patients (mean age 64.3±12.8years) were included. After a mean follow-up of 16.7±6.1months, mean intraocular pressure (IOP) was significantly reduced from 22.7±10.8 to 12.9±4.3mmHg at the last follow-up (p<0.01). Complete success rates at 12months ranged between 71 and 88%, while qualified success rates ranged between 84 and 96%, depending on the criterion adopted (the strictest success criterion was defined as IOP between 6 and 12mmHg). Blebs were graded as good or excellent in 80% of the cases. No serious post-operative complication or avascular blebs were observed. These mid-term results suggest subconjunctival bevacizumab as a safe and effective adjuvant in first-time filtration surgery for primary glaucoma patients.