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G. S. Brar, D. S. Grewal, R. Jain, S. P. S. Grewal; Subconjunctival Bevacizumab as an Adjunct to Reduce Bleb Failure After First-Time Trabeculectomy: One Year Results. Invest. Ophthalmol. Vis. Sci. 2009;50(13):173.
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To determine whether bevacizumab can reduce bleb failure in patients undergoing first-time trabeculectomy for primary open-angle glaucoma (POAG) or chronic angle-closure glaucoma (CACG).
This was a nonrandomized, open-label, prospective, interventional case series comprising of 14 individuals (8 males; 6 females) with a diagnosis of POAG or CACG, a recorded intraocular pressure (IOP) of more than 21 mmHg (between 10 am-12 pm), glaucomatous damage on visual field or optic disc, and taking a maximum tolerated dose of topical IOP-lowering medication. All patients underwent unilateral trabeculectomy with subconjunctival injection of bevacizumab (0.05 ml, 1.25 mg) (Avastin; Genentech, Inc., South San Francisco, CA) adjacent to the bleb using a 30-gauge needle and tuberculin syringe administered immediately after trabeculectomy. A successful trabeculectomy was defined as an un-medicated IOP of 6- 16 mmHg inclusive at 12 months follow-up; evaluation of bleb characteristics according to the Moorfields bleb grading system on months 1, 3, 6 and 12 months; incidence of postoperative intervention with 5-fluorouracil or mitomycin C; bleb needling; and incidence of and time to surgical failure.
Mean age was 55.8±12.8 years. The mean preoperative IOP was 24.8±7.4 mmHg (range, 12-44 mmHg) and the patients were taking an average of 2.8±1.6 topical IOP- lowering medications (range, 1-4). The mean postoperative IOP was 8±3.1 mmHg (range, 4-13 mmHg) on day 1, 10.9±2.8 mmHg (range, 8-16 mmHg) at 1 month, 10.3±2.5 mmHg (range, 7-14 mmHg) at 3 months, 11.6±2.2 mmHg (range, 8-14 mmHg) at 6 months and 12.5 ± 3.2 (range 8-15 mmHg) at 1 year follow-up with no IOP-lowering medications (p=0.001, One-way ANOVA). Preoperative best-corrected visual acuity was 0.70±0.3, whereas at 12 months post-trabeculectomy, it was 0.64±0.2 (p = 0.4, paired t-test). After a mean follow-up of 12 months, of the 14 eyes, a successful trabeculectomy with respect to IOP control was observed in 13 eyes (93%), with an average IOP reduction of 51%.
12 month outcomes support the 6 months results that subconjunctival bevacizumab is a potential adjunctive treatment for reducing the incidence of bleb failure after first-time trabeculectomy.
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