Abstract
Purpose: To evaluate the efficacy of intraoperative sub-conjunctival injection of bevacizumab as an adjunct regiem to trabeculectomy for the treatment of refractory glaucoma. Design: Prospective randomized clinical trial. Patients and Methods: Fifty-five consecutive eyes scheduled for trabeculectomy were randomly included. In the study group (n= 30), bevacizumab (0.05 ml, 1.25 mg) was injected in the sub-conjunctiva adjacent to the bleb using a 30-gauge needle and tuberculin syringe immediately after the surgery. In the control group (n= 25) surgery was completed without bevacizumab injection. Surgical success was defined as a complete success if the intraocular pressure (IOP) was 21 mm Hg or less with an IOP reduction of greater than or equal to 20% without anti-glaucoma medications. Success rates in both groups were compared using Kaplan-Meier survival curves and the log-rank test. The morphologic characteristics of the filtering blebs were evaluated using the Indiana Bleb Appearance Grading Scale. Results: Fifty-five eyes completed the study, with a follow-up of 12 months. Complete success rates were 73.3% for the study group and 70.0% for the control group (P=0.67) at 12 months. Reduction in vascularity of the filtering blebs was statistically significant in the study group (P=0.001). IOP measurements and postoperative complications in both groups were not significant at all visits (P>0.05). Conclusions: Trabeculectomy with intraoperative sub-conjunctival injection of bevacizumab may offer a useful option for improving the outcome of filtering bleb in refractory glaucoma.
Highlights
Unlike most surgical procedures, success of glaucoma filtering surgery is achieved through the inhibition of wound healing [1]
Mitomycin C is widely used to inhibit fibroblast proliferation in trabeculectomy and it results in relatively avascular filtration blebs with less fibro vascular scarring and an increased success rate [2].because of their non-specific mechanisms of action, these agents can cause widespread cell death and apoptosis, resulting in potentially sight-threatening complications such as severe postoperative hypo tony, bleb leaks, and endophthalmitis
Fifty-five eyes of 48 patients were enrolled in the study, of which 30 were assigned to receive trabeculectomy with intraoperative subconjunctival injection of bevacizumb and 25 were assigned to trabeculectomy without intraoperative sub-conjunctival injection of bevacizumb
Summary
Success of glaucoma filtering surgery is achieved through the inhibition of wound healing [1]. The initial steps in wound healing are inflammation and coagulation, leading to a cascade of biological events including cellular, hormonal, and growth factor release. These events lead to scar tissue formation. Mitomycin C is widely used to inhibit fibroblast proliferation in trabeculectomy and it results in relatively avascular filtration blebs with less fibro vascular scarring and an increased success rate [2].because of their non-specific mechanisms of action, these agents can cause widespread cell death and apoptosis, resulting in potentially sight-threatening complications such as severe postoperative hypo tony, bleb leaks, and endophthalmitis.
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