Efficacy and Safety of Bevacizumab Combined with Mitomycin C or 5-Fluorouracil in Primary Trabeculectomy: A Meta-Analysis of Randomized Clinical Trials

Chen, Hung‐Ju; Lin, Chin; Lee, Chien-Hsing; Chen, Yi-Hao

doi:10.1159/000486576

Cited by 10 publications

(7 citation statements)

References 36 publications

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“…In order to improve success rate, antimetabolites primarily mitomycin‐C (MMC) and 5‐fluorouracil (5‐FU) have been introduced in trabeculectomy. However, the application of antimetabolites also increases the risk of bleb leakage, toxic epitheliopathy, prolonged hypotony, blebitis or even endophthalmitis (Collignon‐Brach 1993; Smith et al 1994; Chen et al 2018). Many foreign biomaterials, such as horse hair, silk threads, nylon, gelatin, amniotic membrane and silicone tubes, have also been implanted in glaucoma surgery to aid filtration, but availability issues and cost factors exist.…”

Section: Biomedical Engineering Perspectivesmentioning

confidence: 99%

Anterior lens capsule: biomechanical properties and biomedical engineering perspectives

Huang

Guo

et al. 2020

Acta Ophthalmologica

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Anterior lens capsule, as the thickest basement membrane in the body, has its unique physiology characteristics. In ophthalmology, many attempts have been made to culture different kinds of cells including iris pigment epithelial cells, retinal pigment epithelial cells, corneal epithelium and endothelium cells, trabecular meshwork cells etc and anterior lens capsule has been confirmed to be served as an excellent scaffold for the growth and expansion of different ocular cells. Furthermore, anterior lens capsule also has unique potential in gestation evaluation and the treatment of various ocular diseases, including corneal ulcer, glaucoma, age-related macular degeneration and macular hole, etc. Here, we provide an overview of the biomechanical properties and biomedical engineering perspectives of anterior lens capsule.

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Section: Biomedical Engineering Perspectivesmentioning

confidence: 99%

Anterior lens capsule: biomechanical properties and biomedical engineering perspectives

Huang

Guo

et al. 2020

Acta Ophthalmologica

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“…Some studies examine the efficacy of Bevacizumab, an anti-VEGF drug, alone or together with MMC against post-surgical fibrosis. These experiments showed that combination of both substances did not cause more benefit than using MMC alone [41]. Also, Bevacizumab alone was not more efficient than MMC alone in inhibiting fibrosis after trabeculectomy [42].…”

Section: Discussionmentioning

confidence: 92%

Suppression of the TGF-β pathway by a macrolide antibiotic decreases fibrotic responses by ocular fibroblasts in vitro

et al. 2020

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To elucidate and to inhibit post-surgical fibrotic processes after trabeculectomy in glaucoma therapy, we measured gene expression in a fibrotic cell culture model, based on transforming growth factor TGF-β induction in primary human tenon fibroblasts (hTFs), and used Connectivity Map (CMap) data for drug repositioning. We found that specific molecular mechanisms behind fibrosis are the upregulation of actins, the downregulation of CD34, and the upregulation of inflammatory cytokines such as IL6, IL11 and BMP6 . The macrolide antibiotic Josamycin (JM) reverses these molecular mechanisms according to data from the CMap, and we thus tested JM as an inhibitor of fibrosis. JM was first tested for its toxic effects on hTFs, where it showed no influence on cell viability, but inhibited hTF proliferation in a concentration-dependent manner. We then demonstrated that JM suppresses the synthesis of extracellular matrix (ECM) components. In hTFs stimulated with TGF-β1, JM specifically inhibited α-smooth muslce actin expression, suggesting that it inhibits the transformation of fibroblasts into fibrotic myofibroblasts. In addition, a decrease of components of the ECM such as fibronectin, which is involved in in vivo scarring, was observed. We conclude that JM may be a promising candidate for the treatment of fibrosis after glaucoma filtration surgery or drainage device implantation in vivo .

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“…Comparison of differences in the mean IOP between the two groups did not reveal a significant difference between the two groups; either at Month 6 (p = 0.277), Month 9 (p = 0.564) or at 1 year (p = 0.256); although the mean IOP in the 5-FU + Bevacizumab group was lower on all occasions. 14.33 ± 4.57 [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] 13.86 ± 4.22 [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] 14.5 ± 5.04 Trabeculectomy with 5-FU ø + S/C ¤ Bevacizumab Mean 28.9 ± 18.9 [Maximum 78] [Minimum 14] 12.8 ± 3.89 [5][6][7][8][9][10][11][12][13][14][15][16]…”

Section: Resultsmentioning

confidence: 99%

“…Cheng 10 et al in 2016, searched extensively in the electronic database for randomized controlled trials comparing subconjunctival bevacizumab to other antimetabolites, and concluded that there is inadequate and low quality evidence to recommend or negate its use for wound modulation in GFS. Chen and coworkers 25 in their meta-analysis in 2018, concluded that adjunctive use of bevacizumab (1.25 mg/mL) with a regular concentration of antimetabolites (5-FU or MMC) did not show any advantage or detrimental effect when compared with using antimetabolites alone.…”

Section: Discussionmentioning

confidence: 99%

Subconjunctival Bevacizumab as an Adjunct to 5-Fluorouracil Enhanced Trabeculectomy: 1 Year Outcomes

Nadeem

2021

pak J Ophthalmol

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Purpose: To compare the results of trabeculectomy with subconjunctival Bevacizumab and 5-Fluorouracil (5-FU); with trabeculectomy with 5-FU alone; in terms of intraocular pressure (IOP) lowering, bleb formation, and complications, in the long term. Study Design: Quasi experimental study. Place and Duration of Study: Fauji Foundation Hospital, Rawalpindi, from December 2013 to August, 2019. Methods: A total of 30 eyes (15 in each group) with glaucoma were recruited. Exclusion criteria were previous trabeculectomy, congenital, traumatic, uveitic, neovascular glaucomas, aphakia, or ocular surface disease. Trabeculectomy with 5FU was performed in both groups. In one group, subconjunctival Bevacizumab was injected into the bleb at the end of surgery. The patients were observed for IOP control, bleb configuration, and complications for 1 year. Results: Primary open angle glaucoma was the predominant diagnosis in 17 (56.7%) eyes. The mean pre-operative IOP in the 5-FU group was 30.8 ± 17.03 mmHg, & in the 5-FU+Bevacizumab group it was 28.9 ± 18.9 mmHg. The mean IOPs of the 5-FU group at 1 Year was 14.5 ± 5.04 mmHg. In 5-FU+Bevacizumab group, mean IOPs at 1 year was 12.7 ± 4.38 mmHg. The differences between pre-operative and post-operative IOPs in both groups at 6, 9 and 12 months were statistically significant. However, differences in mean IOPs between the two groups, bleb morphology and complications were not statistically significant. Conclusion: No added benefit of subconjunctival Bevacizumab used as an adjunct to 5-FU enhanced trabeculectomy was found at the end of 1 year follow-up. Key Words: Trabeculectomy, 5-Fluorouracil, Bevacizumab, Glaucoma, Intraocular pressure.

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Efficacy and Safety of Bevacizumab Combined with Mitomycin C or 5-Fluorouracil in Primary Trabeculectomy: A Meta-Analysis of Randomized Clinical Trials

Cited by 10 publications

References 36 publications

Anterior lens capsule: biomechanical properties and biomedical engineering perspectives

Anterior lens capsule: biomechanical properties and biomedical engineering perspectives

Suppression of the TGF-β pathway by a macrolide antibiotic decreases fibrotic responses by ocular fibroblasts in vitro

Subconjunctival Bevacizumab as an Adjunct to 5-Fluorouracil Enhanced Trabeculectomy: 1 Year Outcomes

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