Subconjunctival Bevacizumab Research Articles

Effect of single subconjunctival injection of bevacizumab on primary pterygium: clinical, histopathological and immunohistochemical study.

To evaluate the effect (clinically, histopathologically and immunohistochemically) and safety of a single intra-pterygium injection of bevacizumab. Prospective interventional study comprised 40 eyes of 40 patients with primary fleshy pterygia who attended the Outpatient Clinic of Department of Ophthalmology, Assiut University Hospitals, Egypt from May 2015 to May 2016. Patients were randomly classified into 2 groups: the first group received a single intralesional injection of bevacizumab (Avastin; Genentech, San Francisco, CA, USA); the second group comprised patients who did not receive subconjunctival bevacizumab. Excision of pterygium and conjunctival auto graft was done in both groups. The excised pterygium tissues were subjected to histopathological and immunohistochemical evaluation. The study comprised 40 eyes of 40 patients (33 men, 7 women) of age range from 31-58y. The study group included 22 eyes. The control group included 18 eyes. A decrease in the vascularity of the pterygium was noted in all injected cases. The mean vessel count was higher in non-injected pterygia than that in injected pterygia and the difference was statistically significant (P=0.001). Also, the mean vessel count in both groups was significantly higher than normal conjunctive (P=0.005 and 0.001). A statistically significant difference in vascular endothelial growth factor (VEGF) expression between injected and non-injected cases was detected in the epithelial, stromal and endothelial cells (P=0.0001, 0.016, 0.014). No serious intraoperative complications occurred in both groups. The use of single intra lesional injection of Avastin in pterygium decreased vascularity and decreased VEGF expression in injected pterygium after one month. Our study proved the effect of single intra lesional injection of Avastin on pterygium. Further studies may enable limiting the need for surgery and improve quality of life for patients with pterygia.

Initial trabeculectomy with 5-fluorouracil with or without subconjunctival bevacizumab in the management of pseudoexfoliation glaucoma.

To investigate the outcomes of trabeculectomy with 5-fluorouracil (5-FU) with or without subconjunctival bevacizumab in the surgical management of pseudoexfoliation glaucoma (PXG). This retrospective study consisted of 49 cases with PXG who underwent initial trabeculectomy with 5-FU. The cases were divided into two age- and sex-matched groups. In 23 cases, subconjunctival bevacizumab was injected (1.25mg/0.05mL) at the end of the surgery and in 26 of them the surgery was performed without bevacizumab. The groups were evaluated for the postoperative differences of the intraocular pressure (IOP) and the number of the anti-glaucomatous medications. Independent t, Kolmogorov-Smirnov and Chi square tests were used for statistical analysis. The mean preoperative IOP was 30.91 ± 4.50mmHg under the mean number of 2.4 ± 0.7 drops in bevacizumab group. The IOP decreased to 10.22 ± 2.63mmHg (first week), 10.91 ± 1.88mmHg (first month), 12.35 ± 2.5mmHg (3rd month), 12.65 ± 2.35mmHg (sixth month) and 12.7 ± 1.9mmHg at the final visit. The mean preoperative IOP was 31.27 ± 5.60mmHg under the mean number of 2.3 ± 0.7 drops in without bevacizumab group. The IOP decreased to 10.08 ± 2.59mmHg (first week), 11.00 ± 1.87mmHg (first month), 12.81 ± 2.04 (3rd month), 13.62 ± 2.21mmHg (sixth month) and 12.9 ± 2.4mmHg at the final visit. In both groups, IOP reduced significantly postoperatively. There were no significant differences between the preoperative and the postoperative IOP values. The additional benefit of single dose of intraoperative bevacizumab was not observed in trabeculectomy with 5-FU in PXG.

Effect of subconjunctival Bevacizumab injection on the outcome of Ahmed glaucoma valve implantation: a randomized control trial.

The effect of subconjunctival Bevacizumab injection on the outcome of Ahmed glaucoma valve (AGV) implantation. Evaluation of efficacy and safety of subconjunctival Bevacizumab injection adjunctive to AGV implantation. Prospective and randomized clinical trial. Fifty eyes of 50 patients with diagnosis of glaucoma that were candidate for AGV surgery were included. In 25 eyes, conventional AGV surgery (group 1) and in 25 eyes AGV surgery with subconjunctival Bevacizumab (group 2) was performed by block randomization MAIN OUTCOME MEASURES: The primary outcome measure was surgical success. Outcome measures were compared at postoperative month 3, 6 and 12. Mean age of patients was 58.76 ± 12.11 and 51.36 ± 15.44 years in group 1 and 2 respectively (P = 0.06). Mean intraocular pressure (IOP) at baseline was 24.88 ± 7.62 mmHg in group 1 and 27.52 ± 8.57 mmHg in group 2 which decreased to15.4 ± 4.4 mmHg in group 1 and 13.42 ± 2.9 mmHg in group 2 (P < 0.00) at last follow up. Surgical success was defined in two level: postoperative IOP ≤ 21 mmHg with at least 20% reduction in IOP (Criterion A), either with no medication (complete success) or with no more than two medications (qualified success) and criterion B with the same definition but the IOP ≤ 18 mmHg The cumulative success according to criterion A and B was 77.8%, 72.2% in group 1 and 89.5% in group 2, respectively, at the end of follow-up. Subconjunctival injection of Bevacizumab adjunctive to AGV implantation leads to higher success rate compared with AGV alone in one year follow-up.

Successful single treatment with ziv-aflibercept for existing corneal neovascularization following ocular chemical insult in the rabbit model

PurposeTo evaluate the efficacy of ziv-aflibercept as a treatment for established corneal neovascularization (NV) and to compare its efficacy to that of bevacizumab following ocular chemical insult of sulfur mustard (SM) in the rabbit model. MethodsChemical SM burn was induced in the right eye of NZW rabbits by vapor exposure. Ziv-aflibercept (2 mg) was applied once to neovascularized eyes by subconjunctival injection while subconjunctival bevacizumab (5 mg) was administered twice a week, for 3 weeks. Non-treated exposed eyes served as a control. A clinical follow-up employed by slit-lamp microscope, was performed up to 12 weeks following exposure and digital photographs of the cornea were taken for measurement of blood vessels length using the image analysis software.Eyes were taken for histological evaluation 2, 4 and 8 weeks following treatment for general morphology and for visualization of NV, using H&E and Masson Trichrome stainings, while conjunctival goblet cell density was determined by PAS staining. ResultsCorneal NV developed, starting as early as two weeks after exposure.A single subconjunctival treatment of ziv-aflibercept at 4 weeks post exposure, significantly reduced the extent of existing NV already one week following injection, an effect which lasted for at least 8 weeks following treatment, while NV in the non-treated exposed eyes continued to advance. The extensive reduction in corneal NV in the ziv-aflibercept treated group was confirmed by histological evaluation. Bevacizumab multiple treatment showed a benefit in NV reduction, but to a lesser extent compared to the ziv-aflibercept treatment. Finally, ziv-aflibercept increased the density of conjunctival goblet cells as compared to the exposed non-treated group. ConclusionsSubconjunctival ziv-aflibercept single treatment presented a highly efficient long-term therapeutic benefit in reducing existing corneal NV, following ocular sulfur mustard exposure. These findings show the robust anti-angiogenic efficacy of ziv-aflibercept and demonstrate the advantage of this treatment over the other anti-angiogenic therapies in ameliorating corneal NV and protecting the ocular surface.

Antiscarring effect of intraoperative bevacizumab in experimental glaucoma filtration surgery.

To determine the effects of bevacizumab and mitomycin C alone and in combination on intraocular pressure and the scarring process after modified glaucoma filtration surgery in rabbits. The rabbits underwent modified glaucoma filtration surgery and were allocated into three groups to receive intraoperative treatment with subconjunctival bevacizumab (group A), mitomycin C and subconjunctival bevacizumab (group B), or mitomycin C (group C). Intraocular pressure was measured immediately preoperatively and on postoperative days 8, 14, 17, 21, 26, and 30. The scarring process was assessed 30 days after surgery by tissue section using hematoxylin and eosin, Masson's trichrome, and picrosirius. Expression of vascular endothelial growth factor (VEGF) was assessed by immunohistochemical analyses. All analyses were performed by a masked observer. Animals in group A had higher intraocular pressure than those in groups B and C (p<0.01). Intraocular pressure did not differ significantly between groups B and C. The amount of fibrosis was similar with all stains used: group A had the highest level of fibrosis compared with groups B and C (p>0.05). There was less VEGF expression in group A than in groups B and C (p<0.01). Groups B and C did not differ in VEGF expression. Mean intraocular pressure and fibrosis were lower in animals receiving bevacizumab in combination with mitomycin C but did not differ from values in animals receiving mitomycin C alone. Inhibition of VEGF was greater when bevacizumab was used alone than when bevacizumab was combined with mitomycin C.

Effect of subconjunctival antivascular endothelial growth factor on corneal neovascularization after penetrating keratoplasty

Purpose: To evaluate the effect of subconjunctival anti-VEGF on corneal neovascularisation post penetrating keratoplasty. Methods: A total of 31 eyes of 31 patients with corneal neovascularisation post penetrating keratoplasty were subjected to 2.5 mg/0.1 ml of subconjunctival bevacizumab in each quadrant of neovascularisation. We evaluated the regression of corneal neovascularisation after subconjunctival bevacizumab at 1 week, 4 weeks and 6 weeks and the incidence of complications and subjective complaints related to the treatment was also noted. Results: This was an experimental study, conducted from September 2015 to September 2016. A total of 31 patients with corneal neovascularisation post penetrating keratoplasty were included in the study, out of which 27(87.1%) were males and 4(12.9%) were females. 90.3% of patients had neovascularisation in all 4 quadrants, 6.5% had neovascularisation in 2 quadrants and only 3.2% had neovascularisation in only 1 quadrant. All patients who were subjected to subconjunctival bevcizumab, the regression of neovascularisation at 1 week, 4 weeks and 6 weeks was noted and there was a significant decrease in neovascularisation in central segments 1.97 ± 3.72 as compared to pre 5.13 ±7.12(p=0.001) and also in peripheral segments at 6 weeks 29.90 ± 15.73 as compared to pre bevacizumab 44.32 ± 17.97(p

Subconjunctival bevacizumab versus mitomycin c as adjuvant treatment to subscleral trabeculectomy

Aim To compare the clinical outcome of adjuvant subconjunctival bevacizumab (BVZ) injection versus mitomycin C (MMC) during subscleral trabeculectomy. Patients and methods In this study, 20 patients who were divided into two groups: group A included 10 (20 eyes) patients who underwent subscleral trabeculectomy with subconjunctival injection of 1.25 mg/0.1 ml BVZ, and group B included 10 (20 eyes) patients who underwent subscleral trabeculectomy with adjuvant intraoperative use of 0.2 mg/ml MMC for 2 min. This prospective nonrandomized clinical comparative study was conducted in Nour-El-Hayaha Eye Center (Cairo). Patients were diagnosed for primary open angle glaucoma with uncontrolled intraocular tension by maximum tolerable antiglaucoma therapy. The study excluded patients with neovascular glaucoma, congenital and juvenile glaucoma, history of ocular pathology, or surgery as retinal surgeries and uveitis. Results Twenty patients were considered for the study, nine (45%) patients (18 eyes) were males and 11 (55%) patients (22 eyes) were females. The patients’ ages ranged from 35 to 65 years (mean age 55.2±8.3). Mild hyphema, in one eye in group A (8.33%), wound leak in one (8.33%) eye in each group, and shallow anterior chamber in two (16.7%) cases in each group. It was the most common encountered complication in our study. One (8.33%) case of shallow anterior chamber in group A led to choroidal effusion. One (8.33%) case in group B developed late bleb-related endophthalmitis after 3 months, which ended in phthisis bulbi. Conclusion The success of glaucoma filtration surgery is heralded by a wound healing response mainly mediated by fibroblast proliferation, migration, and contraction that leads to postoperative subconjunctival scar. The effect of subconjunctival BVZ and MMC-augmented trabeculectomy in cases of primary open angle glaucoma was beneficial in improving the success rate with better intraocular pressure control and prolonging the trabeculectomy survival with no significant difference between the two groups.

Bevacizumab and corneal pathology

The purpose of this paper is to present a review of the current literature on anti-vascular endothelial growth factor (anti-VEGF) bevacizumab therapy for corneal neovascular disorders. Cornea is unique avascular, immunoprivileged connective tissue that acts as transparent mechanical barrier and the anterior eye refractive surface. Corneal neovascularizations (NV) are caused by chronic corneal ischemia with pathological ingrowth of perylimbal blood vessels into the cornea. Abnormal blood vessels cause scarring of the cornea and compromise visual acuity. Pathological conditions that cause corneal neoangiogenesis are: chemical burns, ischemia, infections, degeneration, trauma and immune processes. Corneal neovascularization occurs because of corneal pro-angiogenic and anti-angiogenic factors disequilibrium. The former treatment of corneal NV does not target the molecular mediators of angiogenesis. VEGF-A is the main regulator of angiogenesis. Bevacizumab recognizes all VEGF isoforms. Studies have demonstrated partial reduction of neovascularization through topical, subconjunctival and intrastromal bevacizumab application. Bevacizumab can be used in corneal inflammatory diseases, infections and traumatic/iatrogenic causes. Anti-VEGF agents have created enormous hope for the treatment of corneal neovascularization. Treatment of corneal NV with anti-VEGF antibody has limits and depends on the size of the scar, durability and range of neovascularization. Anti-VEGF agents are especially effective when administered early (less then 2 weeks in neoangiogenesis). Controlled prospective studies are needed to establish long-term safety, efficacy and minimum effective and maximum security concentration of the drug to treat neovascularisation of anterior eye segment.

Subconjunctival Bevacizumab Injection Impairs Corneal Innervations and Epithelial Wound Healing in Mice.

To investigate the effects of subconjunctival bevacizumab injection on the corneal nerve, sensitivity, and epithelial wound healing in mice. Adult C57BL/6 mice were treated with subconjunctival injection of 1, 2, 5, or 25 mg/mL bevacizumab. The corneal nerve was observed with whole-mount anti-β3-tubulin fluorescence staining. Corneal sensitivity was measured with a Cochet-Bonnet esthesiometer. The protein levels of pigment epithelium-derived factor (PEDF), nerve growth factor (NGF), glial-derived neurotrophic factor (GDNF), and ciliary neurotrophic factor (CNTF) were measured by ELISA. The corneal epithelial wound-healing rate was evaluated by fluorescein staining. The recovery of impaired mouse corneal innervations and epithelial wound-healing rate following bevacizumab injection was evaluated with the co-injection of PEDF, NGF, or CNTF. Subconjunctival bevacizumab injection caused apparent corneal nerve degeneration, attenuated corneal sensitivity, and delayed corneal epithelial wound healing and nerve regeneration in normal mice, which was more significant with increased concentration and times of the bevacizumab injection. However, the corneal nerve and sensitivity gradually improved and recovered in mice with a single injection of 1 to 5 mg/mL bevacizumab. Moreover, the bevacizumab injection significantly decreased the corneal PEDF, NGF, and CNTF content, whereas exogenous PEDF, NGF, or CNTF supplement attenuated impairment of the corneal nerve, sensitivity, and epithelial wound healing after subconjunctival bevacizumab injection. Subconjunctival bevacizumab injection impairs corneal innervations, epithelial wound healing, and nerve regeneration in normal mice, which may be caused by the reduction of neurotrophic factor content in the cornea.

Efficacy and Safety of a Large Conjunctival Autograft for Recurrent Pterygium.

PurposeTo evaluate the efficacy and safety of pterygium excision using a large conjunctival autograft for the treatment of recurrent pterygium.MethodsThe medical records of 120 patients (126 eyes) with recurrent pterygium were reviewed. For each affected eye, pterygium excision with a large conjunctival autograft was performed. The graft was harvested from the superior bulbar area and measured more than 8 × 10 mm in size. Only patients who completed at least six months of follow-up were included. Postoperative clinical outcomes, recurrence rate, and complications were analyzed. Patients with any evidence of recurrence after surgery received a subconjunctival bevacizumab injection.ResultsThe average patient age was 56.5 ± 10.2 years, and 45 out of 120 patients were male. The mean study follow-up period was 17.7 ± 17.6 months. Most patients were satisfied with the cosmetic outcome. Postoperative visual acuity improved from 0.69 to 0.75 (p < 0.05). Postoperative refractive astigmatism and corneal astigmatism decreased by 0.55 and 2.73 diopters, respectively (p < 0.05). The postoperative recurrence rate was 4.0%, and the average recurrence period was 7.4 ± 0.6 weeks. A subconjunctival injection of 5 mg bevacizumab was performed in cases of recurrence; no progression of the pterygium was observed following the injection. Postoperative complications included 2 cases of conjunctival graft edema in 2 eyes, 5 donor site scars in 5 eyes, 13 pyogenic granulomas in 13 eyes, and a conjunctival epithelial inclusion cyst in 7 eyes.ConclusionsPterygium excision with a large conjunctival autograft for the treatment of recurrent pterygium produced an excellent cosmetic outcome, a low recurrence rate, and minimal complications. A subconjunctival bevacizumab injection given in cases of recurrence following surgery might be effective in preventing progression of the pterygium.

Efficacy of Subconjunctival Bevacizumab Injections before and after Surgical Excision in Preventing Pterygium Recurrence.

Purpose To evaluate the efficacy of subconjunctival bevacizumab injections, before and after surgical excision with bare sclera technique, in preventing postoperative pterygium recurrence. Material and Methods 83 eyes of 83 patients affected with primary pterygia underwent surgical excision. 42 eyes received two subconjunctival bevacizumab injections, at the dosage of 2.5 mg/0.1 ml, one week prior surgery and one week after intervention. Recurrence rate was evaluated among the two groups. Moreover, modifications of pterygium size and grade one week after the first injection were evaluated. Results At 6 months after surgery, the recurrence rate was 7.14% in the bevacizumab group and 24.39% in the control group. Significant changes of pterygium size and grade were reported after the first injection. No important complications related to bevacizumab subconjunctival injections were registered. Conclusions The application of subconjunctival bevacizumab injections, at the dosage of 2.5 mg/0.1 ml, before and after surgical pterygium excision, may be useful in preventing lesion recurrence after bare scleral procedures. Furthermore, bevacizumab subconjunctival administration is well tolerated and may represent a safer alternative if compared with other surgical techniques and adjunctive drugs. This trial is retrospectively registered with ISRCTN Registry on 18 April 2017, TRN: ISRCTN11424742.

Two Cases of Corneal Neovascularization Improved by Electrocauterization and Subconjunctival Bevacizumab Injection

Two Cases of Corneal Neovascularization Improved by Electrocauterization and Subconjunctival Bevacizumab Injection

Combined sutureless gluefree conjunctival autograft with subconjunctival bevacizumab for treatment of primary pterygium

Combined sutureless gluefree conjunctival autograft with subconjunctival bevacizumab for treatment of primary pterygium

Fine-Needle Diathermy with Simultaneous Subconjunctival Bevacizumab

ABSTRACTPurpose: To describe our experience of the use of subconjunctival bevacizumab in conjunction with fine-needle diathermy for the treatment of corneal vascularization. Methods: Retrospective analysis of cases treated between 2010 and 2013. Results: Those patients with corneal lipid deposition had good results following treatment with 3/5 cases requiring more than one session of treatment. A single patient with severe atopy and multiple previous failed penetrating keratoplasty underwent five sessions of treatment but his third graft subsequently also failed. Conclusion: Concurrent use of subconjunctival bevacizumab with FND gives good results in patients with lipid deposition; however, the management of cases with ongoing inflammatory processes is much more challenging.

Traitements comparés de la néovascularisation cornéenne : injections sous-conjonctivales de bévacizumab et/ou photothérapie dynamique

To evaluate and compare the efficacy of subconjunctival bevacizumab injections alone, photodynamic therapy alone and combined treatments for reduction of corneal neovascularization. This study was conducted as a prospective case series. A total of seven eyes of 7 patients with corneal neovascularization caused by ocular surface disorders including fungal infectious keratitis and penetrating keratoplasty were included in the study. Patients were randomized into the three following groups: patients in group A received a single subconjunctival injection of 10mg (0.4mL) of bevacizumab, patients in group B were treated with photodynamic therapy with verteporfin (6mg/m(2)) to the neovascularized area and those in group C received a subconjunctival injection of bevacizumab and photodynamic therapy 7 days later. Morphological changes in neovascularization were evaluated over 6 months using slit-lamp biomicroscopy and digital corneal photography. A computer-assisted semi-automatic analysis of the area of corneal neovascularization was performed with Image J software. Recession of corneal vessels was observed in all eyes at 1 month post-treatment. The neovascularized surface area in all groups combined showed a decrease in the first month after treatment and this decrease continued up to the 6th month. The surface area of corneal neovascularization decreased by 34.05±8.28% in group A (subconjunctival injection of bevacizumab), by 42.06±28.36% in group B (photodynamic therapy with verteporfin) and by 51.67±18.93% in group C (combined subconjunctival injection of bevacizumab and photodynamic therapy). A combined treatment consisting of a subconjunctival injection followed by a PDT session 7 days later might be more effective for the treatment of corneal neovascularisation. No serious local or systemic adverse events were observed. Our medium-term results suggest that combined subconjunctival injection of bevacizumab and photodynamic therapy with verteporfin might be used safely and effectively to reduce corneal neovascularization surface. This combined therapy may show a tendency toward greater efficacy than the individual monotherapies. Controlled prospective randomized multicentric trials with a larger sample size are necessary to assess long-term efficacy and to confirm these results.

Comparative Study of Tacrolimus and Bevacizumab on Corneal Neovascularization in Rabbits

PurposeTo compare the anti‐angiogenic effects of tacrolimus and bevacizumab on corneal neovascularization in rabbits.MethodsNeovascularization was induced in 32 eyes of 16 rabbits by placing suture in the corneal stroma. Seven days after suture placement, all rabbits were divided into four groups and were treated subconjunctivally with bevacizumab 0.05 mL (5 mg/0.05 mL; AVA_sub), Tacrolimus 0.05 mL (0.25 mg/0.05 mL; TAC_sub), balanced salt solution (0.05mL was subconjunctivally injected in one eye of each rabbit and applied by eye drops in the other eye, control group), and Tacrolimus eye drops (5 mg/5 mL applied four times daily; TAC_drop). Digital photographs were obtained and the surface area of corneal neovascularization was measured 7 days after subconjunctival injections. Corneal specimens were analyzed histopathologically and were used to measure the concentration of VEGF, TNF‐α, IFN‐γ, IL‐1β, and MCP‐1 mRNA by RT‐PCR.ResultsIn digital photographs, the neovascularized area was decreased in all treatment groups (AVA_sub 0.58, TAC_sub 0.60, TAC_drop 0.68) compared with the control group (BSS 0.81). The histological examination showed markedly regressed new vessels in treatment groups, and the immunohistochemical staining revealed weakly stained with anti‐VEGF and anti‐F4/80 antibodies in the treatment groups. In semi‐quantitative RT‐PCR, the concentration of VEGF (AVA _sub 0.24, TAC_drop 0.18), TNF‐α (AVA_sub 0.19, TAC_sub 0.24, TAC_drop 0.15), and IL‐1ß (AVA_sub 0.19, TAC_sub 0.33, TAC_drop 0.18) mRNA were significantly lower in the treatment groups than in the control group (VEGF 0.47, TNF‐α 0.44, IL‐1β 0.87) (P &lt; 0.05).ConclusionsTopical and subconjunctival tacrolimus application may be useful in reducing corneal neovascularization and have comparable effects to subconjunctival bevacizumab injection.

Corneal Fine Needle Diathermy With Adjuvant Bevacizumab to Treat Corneal Neovascularization in Children.

To report the outcomes of corneal fine needle diathermy (FND) with adjuvant intrastromal and subconjunctival bevacizumab injection for corneal neovascularization (CN) in children. Medical records of all children who had undergone FND with adjuvant bevacizumab injection were reviewed retrospectively. Treatment efficacy was evaluated by changes in visual acuity, regression of CN, and clearing of lipid deposits with the aid of slit-lamp color images that were taken before surgical intervention and at last follow-up visit. Postoperative complications were recorded and served to assess the safety of the procedure. Nine eyes of 9 patients were included in the study. The mean age of the patients was 8.4 ± 4.2 years (4-15 years) and the mean follow-up time was 18.7 ± 12.2 months (5-35 months). Three eyes had a history of herpes simplex keratitis (HSK), 3 eyes had complete corneal anesthesia, 2 eyes had CN following suture tract infection after corneal transplant for HSK scar and limbal dermoid excision, and 1 eye had blepharokeratoconjunctivitis. After treatment, 8 eyes had complete CN resolution, and 1 eye with corneal anesthesia following brain tumor resection had partial regression in vessel distribution and size. Lipid deposition clearance lagged behind CN resolution. Mean duration of CN before treatment was 15.3 ± 14.0 months (1-37 months). Mean corrected distance visual acuity before and after surgery was 0.66 ± 0.31 and 0.50 ± 0.37 logMAR, respectively (P = 0.02). Corneal FND with adjuvant bevacizumab injection is effective at treating sectorial corneal vessels in children.

Nivel de presión intraocular con el uso de 5-fluorouracilo frente a bevacizumab en pacientes con glaucoma e implante de válvula de Ahmed que presentan quiste de Tenon

PurposeDetermine the level of intraocular pressure after the use of subconjunctival 5-fluorouracil and bevacizumab in patients with glaucoma and Ahmed valve with Tenon's cyst. Patients and methodExperimental, prospective, longitudinal, randomized controlled clinical trial. Twenty patients were divided in 2 groups according to the designated treatment, 5-fluorouracil and bevacizumab with a 3-month follow-up to assess the effects of each drug on the intraocular pressure. ResultTen patients were included in each group. The initial intraocular pressure was 37.8±8.8mmHg for the bevacizumab group and 38.7±12.65mmHg for the 5-fluorouracil group. After a 3 month follow-up, intraocular pressure lowered to 23±6.5mmHg in bevacizumab group, compared to 22.9±9.5mmHg in 5-fluorouracil group. The use of hypotensive drugs was significantly lower in both groups with no statistical difference between them. ConclusionIntraocular pressure was similar with the use of subconjunctival 5-fluorouracil and bevacizumab in patients with glaucoma and Ahmed valve with Tenon's cyst.

Role of Subconjunctival Bevacizumab as an Adjuvant to Primary Trabeculectomy

To compare the safety and efficacy of primary trabeculectomy with adjunctive subconjunctival bevacizumab with that of primary trabeculectomy with mitomycin C (MMC). Forty-two patients with primary open-angle glaucoma were studied. Randomly, subject's eyes underwent primary trabeculectomy with either subconjunctival bevacizumab (2.5 mg/0.1 mL) or topical MMC (0.2 mg/mL for 3 min). The intraocular pressure (IOP) was the primary outcome measure. Secondary outcome measures included the corrected distance visual acuity, number of antiglaucoma medications, postoperative interventions and complications, bleb evaluation (on the basis of Moorfields Bleb Grading System), and the percentage of eyes achieving target pressure of 21, 18, 15, and 12 mm Hg at 6 and 12 months postoperatively. Of the 42 eyes, 21 treated with subconjunctival bevacizumab while 21 were treated with MMC. The mean preoperative IOP in the bevacizumab group improved from 23.9 ± 2.7 mm Hg with 2.6 ± 0.7 antiglaucoma medications to 13.9 ± 2.8 mm Hg with 0.6 ± 0.9 antiglaucoma medications at 12 months (P<0.001 and P<0.001, respectively). The mean preoperative IOP in MMC group improved from 22.9 ± 2.6 mm Hg with 2.7 ± 0.8 antiglaucoma medications to 12.2 ± 3.2 mm Hg with 0.1 ± 0.5 antiglaucoma medications at 12 months (P<0.001 and P<0.001, respectively). At 12 months, 15 of 21 (71%) eyes in the MMC group met a target IOP of 12 mm Hg without antiglaucoma medication while 7 of 21 (33%) eyes in the bevacizumab group did (P=0.02). Encapsulated bleb was seen in 2 (10%) patients in MMC group and in 6 (29%) patients in bevacizumab group (P=0.23). Although subconjunctival bevacizumab is effective and safe in primary trabeculectomy, IOP control appears to be superior with MMC, in terms of complete success with a target IOP<12 mm Hg and number of antiglaucoma medications required postoperatively.

Deep Sclerectomy With Bevacizumab and Mitomycin C

To assess the comparative efficacy and safety of primary deep sclerectomy (DS) augmented with subconjunctival Bevacizumab and intraoperative Mitomycin C (MMC). Retrospective, comparative case-control series of consecutive primary DS between January 2008 and December 2010. Seventy-five eyes of 73 patients were included, with 32 eyes in the MMC and 43 in the Bevacizumab group. MMC (0.2 mg/mL for 2 min) was applied subconjunctivally before scleral flap dissection. Bevacizumab (2.5 mg in 0.1 mL) was injected subconjunctivally at the end of surgery. Complete success was intraocular pressure (IOP) <19 mm Hg and a 20% decrease from baseline with no postoperative medications. There were no significant baseline differences between the groups. Follow-up after DS was 33.3 ± 6.1 months for the Bevacizumab and 35.0 ± 10.2 months for the MMC group (P=0.34). Complete success rates were 90.7% [95% confidence interval (CI), 82.4%-99.8%] and 87.5% (95% CI, 76.8%-99.7%) at 1 year and 76.5% (95% CI, 64.8%-90.4%) and 74.4% (95% CI, 60.5%-91.4%) at 2 years after DS in the Bevacizumab and MMC groups, respectively (P=0.52). There was no statistical difference in mean IOPs between the groups at all specified time intervals up to 2 years (P=0.28). At last follow-up 2 (6.2%) of the MMC and 2 (4.7%) eyes of Bevacizumab group were on medications to control IOP. Eighteen eyes had complications, 9 (20.9%) in Bevacizumab and 9 (28.1%) in the MMC group (P=0.8). Subconjunctival Bevacizumab with primary DS appears to be as efficacious as MMC augmentation with no additional side effects.