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

Miraftabi, Arezoo; Nilforushan, Naveed; Darghahi, Mina; Alemzadeh, Sayyed Amirpooya; Parsamanesh, Mohammad; Yadgari, Maryam

doi:10.1111/ceo.13191

Cited by 7 publications

(18 citation statements)

References 27 publications

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“…The inclusion and exclusion criteria were applied to the full texts of the remaining 38 studies after which a total of 5 RCTs were included in this metaanalysis. [25][26][27][28][29] Notably, preliminary searches did not identify any suitable RCTs for inclusion of non-valved implants.…”

Section: Study Selectionmentioning

confidence: 99%

“…The 3 remaining studies administered subconjunctival bevacizumab (SCB) at the end of the operation or day 1 after the operation in patients with all types of refractory glaucoma. 25,28,29 The Cochrane Risk of Bias 2.0 tool was applied to assess the included RCTs for methodological soundness by 2 authors (L.T. and J.V.).…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

“…18 As depicted in Figure 2, all 5 studies had some concerns. [25][26][27][28][29] The number of included studies (n = 5) was inadequate for the application of funnel plot assessment or regression-based techniques in the detection of publication bias. 20,21 Mean Intraocular Pressure All 5 RCTs [25][26][27][28][29] reported mean IOP at 1 month and 3 months, whereas 4 studies [26][27][28][29] reported mean IOP at 6 months, 12 months, and beyond.…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

“…[25][26][27][28][29] The number of included studies (n = 5) was inadequate for the application of funnel plot assessment or regression-based techniques in the detection of publication bias. 20,21 Mean Intraocular Pressure All 5 RCTs [25][26][27][28][29] reported mean IOP at 1 month and 3 months, whereas 4 studies [26][27][28][29] reported mean IOP at 6 months, 12 months, and beyond. There was a tendency for the bevacizumab group to have lower mean IOP at all common follow-up points with mean IOP difference between groups ranging from −2.74 mm Hg (−6.45 to 0.97) at 1 month to −3.74 mm Hg (−10.17 to 2.68) at 6 months.…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

“…While 4 studies [26][27][28][29] reported success outcomes for an IOP target of ≤ 21 mm Hg, only 1 study reported on other IOP targets. 28 Meta-analysis could, therefore, not be conducted for other IOP targets as planned ( ≤ 17 mm Hg and ≤ 12 mm Hg).…”

Section: Success Ratementioning

confidence: 99%

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Does Bevacizumab Improve Outcomes After Ahmed Glaucoma Valve Implantation for Refractory Glaucoma?: A Meta-Analysis

Tran,

Vo,

Bell

et al. 2024

Journal of Glaucoma

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Prècis: Mean IOP, complete and overall success, mean IOP-lowering medications, incidence of hypertensive phase and complications were found to be comparable between patients undergoing Ahmed Glaucoma Valve implantation (AGVI) with adjunctive bevacizumab versus AGVI alone. Purpose: This meta-analysis aims to assess how adjunctive bevacizumab impacts the surgical outcomes of Ahmed glaucoma valve implantation (AGVI) compared to AGVI alone in all subtypes of refractory glaucoma. Methods: A systematic search of databases for relevant randomised controlled trials (RCTs) was performed in March 2023. Primary outcomes included mean intraocular pressure (IOP) and success rates. Secondary outcomes were mean IOP-lowering medications, incidence of hypertensive phase, and complications. Qualitative assessment, meta-analysis, subgroup analyses, and sensitivity analysis were performed. Results: Five RCTs comprising 203 eyes were included in the quantitative analysis. Initial meta-analysis showed a strong yet non-significant trend (all P>0.05) favouring adjunctive bevacizumab in all outcomes of interest. Significant heterogeneity was observed for mean IOP and success outcomes at all timepoints (all I2>50%). Subgroup analysis of administration route revealed a reduced incidence of hyphaema in the intravitreal bevacizumab (IVB) subgroup (OR, 0.10; 95% CI, 0.02–0.59; P=0.01) with significant heterogeneity persisting in the IVB subgroup for all measures (all I2>50%). Post hoc sensitivity analysis of studies without concurrent PRP for mean IOP and success outcomes demonstrated more conservative effect sizes with a corresponding decrease in heterogeneity for all measures (all I2<30%). Conclusion: Published studies investigating the role of adjunctive bevacizumab show a strong trend to improved outcomes but contain a relatively small number of participants. This analysis underpins the need for an adequately powered RCT to explore the role of anti-VEGF agents in AGVI surgery.

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Section: Study Selectionmentioning

confidence: 99%

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

Section: Success Ratementioning

confidence: 99%

See 3 more Smart Citations

Does Bevacizumab Improve Outcomes After Ahmed Glaucoma Valve Implantation for Refractory Glaucoma?: A Meta-Analysis

Tran,

Vo,

Bell

et al. 2024

Journal of Glaucoma

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Anti-Vascular Endothelial Growth Factor for Neovascular Glaucoma

Viruni

Cai

2022

Essentials in Ophthalmology

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The efficacy of adjunctive mitomycin C and/or anti-VEGF agents on glaucoma tube shunt drainage device surgeries: a systematic review

Figueiredo,

Barbosa-Breda

2024

Graefes Arch Clin Exp Ophthalmol

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Purpose The effectiveness of mitomycin C (MMC) in trabeculectomy has long been established. The aim of this review is to evaluate the efficacy and safety of adjunctive agents in tube shunt drainage device surgery for glaucoma or ocular hypertension, since controversy still exists regarding their benefit. Methods We searched CENTRAL, PubMed, Embase, Web of Science, Scopus, and BASE for RCTs, which have used adjuvant antimetabolites—either MMC or 5-Fluorouracil (5-FU)—and/or anti-vascular endothelial growth factors (anti-VEGF) agents. The main outcome was IOP reduction at 12 months. Results Ten studies met our inclusion criteria. Nine used the Ahmed Glaucoma Valve (AGV) implant, while the double-plate Molteno implant was used in one study. Four studies used MMC. The remaining six studies used an anti-VEGF drug – either bevacizumab, ranibizumab or conbercept. Only one MMC-study reported a significant difference in the IOP reduction between groups at 12 months, favouring the MMC group (55% and 51%; p < 0.01). A significant difference was also reported by two out of five bevacizumab-studies, both favouring the bevacizumab group (55% and 51%, p < 0.05; 58% and 27%, p < 0.05), with the highest benefit seen in neovascular glaucoma cases, especially when panretinal photocoagulation (PRP) was also used. Neither ranibizumab nor conbercept were found to produce significant differences between groups regarding IOP reduction. Conclusion There is no high-quality evidence to support the use of MMC in tube shunt surgery. As for anti-VEGF agents, specifically bevacizumab, significant benefit seems to exist in neovascular glaucoma patients, especially if combined with PRP.

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

Abstract: Subconjunctival injection of Bevacizumab adjunctive to AGV implantation leads to higher success rate compared with AGV alone in one year follow-up.

Cited by 7 publications

References 27 publications

Does Bevacizumab Improve Outcomes After Ahmed Glaucoma Valve Implantation for Refractory Glaucoma?: A Meta-Analysis

Does Bevacizumab Improve Outcomes After Ahmed Glaucoma Valve Implantation for Refractory Glaucoma?: A Meta-Analysis

Anti-Vascular Endothelial Growth Factor for Neovascular Glaucoma

The efficacy of adjunctive mitomycin C and/or anti-VEGF agents on glaucoma tube shunt drainage device surgeries: a systematic review

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