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Alok K. Gupta, Nitin Anand; Bevacizumab Augmented Deep Sclerectomy: A Comparative Case Control Study. Invest. Ophthalmol. Vis. Sci. 2011;52(14):645.
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To assess the comparative efficacy and safety of enhancing primary phakic Deep Sclerectomy (DS) with subconjunctival bevacizumab (Avastin) or MitomycinC application intraoperatively.
Retrospective short-term comparative case control study. Consecutive primary phakic DS between Jan 2008 and Dec 2009 with a minimum follow up of 6 months were included. Mitomycin C (MMC) 0.2 mg/ml was applied for 2 minutes under the conjunctiva after dissection of superficial scleral flap. Bevacizumab 0.1 ml (2.5mg) was injected subconjunctivally at the surgical site after completion of surgery.26 eyes in avastin group and 27 eyes in MMC groupAge 70.7+/-10.1 in avastin group and 66.6+/- 10.1 in MMC group Caucasian were the commonest race, and POAG the commonest diagnosis. Mean follow up was 12.7+/-2.8 in avastin group and 19.2+/-5.3 in MMC group. Preoperative IOP was 23.4+/-7.7 in avastin group and 22.7+/-8.4 in MMC group. Preoperative medications were 2.4+/-0.9 in avastin group and 2.5+/-1.0 in MMC group. Spacer device was used in 16 cases in avastin group and 19 cases in MMC group. Laser Goniopuncture (LGP) was delayed for atleast 3 months after surgery.
Complete success taken as IOP< 18 and 20% drop from preoperative level with no LGP and medications, was 80% at 6 months and 70% at 12 months in avastin group, and 70% at 6 months and 67% at 12 months in MMC group. Partial success was IOP<18 and 20% drop witn or without LGP and medications was 86% at 6 months and 83% at 12 months in avastin group and 80% and 77% in MMc group at 6 and 12 months respectively. Mean follow up was 12.7+/-2.8 months in avastin group and 19.2+/-5.3 months in MMC group. LGP was done in 4 eyes in avastin group and in 6 eyes in MMC group. Needle revision or further glaucoma surgery was considered as failure by both criteria. Conjunctival edge leaks were seen in 3 cases in avastin group and none in MMC group, choroidal detachment was seen in 3 cases in avastin and 2 cases in MMC group. There was no bleb failure seen in avastin group, but 3 in MMC group.
The preliminary results indicate that augmentation of primary DS with a single intraoperative subconjunctival injection of Bevacizumab may be as effective as intraoperative MMC augmentation in lowering IOP. Longer follow-ups and large number of patients will be needed to confirm this observation. There were no additional side effects noted with its use.
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