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Y. Takihara, M. Inatani, T. Kawaji, M. Fukushima, K. Iwao, M. Iwao, H. Tanihara; Combined Intravitreal Bevacizumab and Trabeculectomy With Mitomycin C Versus Trabeculectomy With Mitomycin C for Neovascular Glaucoma. Invest. Ophthalmol. Vis. Sci. 2009;50(13):174.
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To evaluate the effects of intravitreal bevacizumab (IVB) prior to trabeculectomy with mitomycin C (MMC) for the treatment of neovascular glaucoma (NVG).
We retrospectively reviewed the medical records of patients with NVG who underwent trabeculectomy with MMC. The study group comprised 57 eyes from 50 patients with NVG who underwent trabeculectomy: 24 eyes were treated with a combination of IVB and trabeculectomy after May 18, 2007 when the off-label use of bevacizumab was approved by the Institutional Review Board at Kumamoto University (IVB group) and 33 eyes were treated with trabeculectomy alone between June 1, 2005 and May 17, 2007 (control group). No eyes underwent prior filtering surgeries. In the IVB group, 1.25 mg IVB was injected 1-5 days before trabeculectomy. Preoperative patient characteristics, postoperative complications, IOPs, and survival rates were compared between the two groups. Surgical failure was defined as an IOP ≥ 22 mmHg which was verified at the next visit, a deterioration of visual acuity to no light perception, or additional glaucoma surgeries.
The follow-up period was significantly longer in the control group than the IVB group (613.1 ± 266.6 vs. 254.5 ± 118.5 days; P < 0.0001). There were no significant differences in preoperative patient data between the groups. The most frequent complication after trabeculectomy was hyphema, which occurred significantly less often in the IVB group than the control group (P = 0.006). The IOPs at 7 and 10 days after trabeculectomy were significantly lower in the IVB group than the control group (P = 0.01 and 0.02, respectively). However, Kaplan-Meier survival-curve analysis showed success rates 120, 240, and 360 days after trabeculectomy of 86.4%, 74.4%, and 62.0% in the IVB group, and 74.3%, 71.0%, and 64.1% in the control group, respectively. No significant difference in survival times was found between the groups (P = 0.71).
IVB injection before trabeculectomy reduced postoperative hyphema in NVG eyes. IVB injection transiently controlled IOP after trabeculectomy, but did not significantly contribute to positive surgical outcome over longer periods.
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