Abstract
Purpose: :
To report the short-term outcomes of a surgical technique using subconjunctival bevacizumab as adjuvant in first-time surgery for primary open-angle glaucoma (POAG) or chronic angle-closure glaucoma (CACG).
Methods: :
Noncomparative, interventional case series in which consecutive primary glaucoma patients (POAG and CACG) underwent glaucoma surgery with subconjunctival application of bevacizumab. Each patient underwent standard trabeculectomy with mitomycin C [combined (group II) or not (group I) with phacoemulsification and intraocular lens implantation], and received a 1.25 mg of subconjunctival bevacizumab injection at completion of the surgery. Preoperative and postoperative IOP, number of antiglaucoma medications, best-corrected visual acuity, filtering bleb morphology, surgical complications, and any subsequent related events or procedures were recorded. Bleb morphology was evaluated using a standardized system based on vascularity, extension and height [grades: from 0 (worst) to 3 (best)].
Results: :
A total of 36 eyes from 36 patients (mean age, 68.4+/-9.8 years) were included in the study. Twenty-one patients had open-angle glaucoma and fifteen had angle-closure glaucoma. Mean follow-up was 8.5+/-3.4 months in group I and 4.6+/-2.7 months in group II. Mean IOP was significantly reduced from 22.3+/-7.3 to 10.5+/-2.8 mm Hg at the last follow-up visit in group I and from 19.9+/-6.4 to 10.6+/-2.7 mm Hg in group II (P<0.0001). The mean number of antiglaucoma medications was significantly reduced from 3.1+/-0.58 to 0.3+/-0.7 in group I and from 3+/-0.9 to 0.3+/-0.6 in group II (P<0.0001). Out of the 36 eyes, 29 (80.5%) had bleb morphology graded ³2. Complete (6<IOP<18mmHg without medication) and qualified success (6<IOP<18mmHg with medication) rates were 85 % and 15 % in group I, and 68,8% and 31.2% in group II. Needling was required in 3 eyes of each group. No serious postoperative complication was observed, and none of the eyes presented with avascular bleb at last follow-up visit.
Conclusions: :
Our findings suggest that using subconjunctival bevacizumab as adjuvant in in first-time surgery for primary glaucoma is an effective alternative for glaucoma management with minor postoperative complications.
Keywords: intraocular pressure • drug toxicity/drug effects • optic nerve