Role of Subconjunctival Bevacizumab as an Adjuvant to Primary Trabeculectomy

Akkan, Julide U.; Cilsim, Semih

doi:10.1097/ijg.0b013e318287abf3

Cited by 52 publications

(62 citation statements)

References 40 publications

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“…However, the success rate of this surgery has been limited by postoperative fibroblast proliferation and scarring of the filtering bleb. 1 Numerous adjunctive modifications, such as antimetabolites, 2 b-radiation, 3 and anti-VEGF agents, 4 have been developed to prevent scarring.…”

Section: Introductionmentioning

confidence: 99%

Trabeculectomy with ologen in secondary glaucomas following failed trabeculectomy with MMC: comparative study

El-Saied¹,

Abdelhakim²

2016

Eye

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Section: Introductionmentioning

confidence: 99%

Trabeculectomy with ologen in secondary glaucomas following failed trabeculectomy with MMC: comparative study

El-Saied¹,

Abdelhakim²

2016

Eye

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“…In the case of anti-VEGF, recent studies question their effectiveness. Thus, according to Akkan and Cilsim, bevacizumab achieved a lower IOP reduction and an increased incidence of encapsulated blebs 1 year after trabeculectomy [31] . In the case of the amniotic membrane, its use has not been extended despite its promising results [12] .…”

Section: Discussionmentioning

confidence: 99%

Subconjunctival PRGF Fibrin Membrane as an Adjuvant to Nonpenetrating Deep Sclerectomy: A 2-Year Pilot Study

Rodríguez-Agirretxe

Freire²,

Muruzábal

et al. 2017

Ophthalmic Res

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Purpose: To evaluate the potential role of the autologous PRGF (plasma rich in growth factors) fibrin membrane in tissue regeneration after glaucoma filtering surgery. Materials and Methods: Ten patients with medically uncontrolled primary open-angle glaucoma underwent nonpenetrating deep sclerectomy and were treated with PRGF fibrin membrane as adjuvant. Intraocular pressure reduction was the primary outcome. This variable was measured preoperatively and also at each follow-up visit. Secondary outcomes included the number of antiglaucoma medications, anterior segment optical coherence tomography bleb examination, photographic bleb evaluation, and subjective clinical symptomatology evaluation. Results: The surgical technique showed a significant reduction (p < 0.05) in intraocular pressure in relation to preoperative values at each time of the study, decreasing from 23.3 ± 6.4 to 15.2 ± 4.6 mm Hg at 2 years. Furthermore, the number of antiglaucoma medications consumed showed a significant reduction at the end point of the study compared with the preoperative situation. Optical coherence tomography and photographic filtering bleb variables experienced a progressive reduction during the follow-up. Subjective symptoms showed a reduction from 8.3 ± 4.5 to 4.2 ± 5.3 at 2 years. Conclusions: PRGF-Endoret treatment could promote ocular surface regeneration after glaucoma surgery, enhancing the surgery success rates and reducing the need for postoperative medications. It is important to highlight that this is a preliminary study and some large clinical studies are necessary to verify these results.

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“…Bevacizumab was identified as a potential agent in conjunction with trabeculectomy [7,22,23]. However, bevacizumab alone may not be as effective as MMC in the long-term control of IOP [11,22,23].…”

Section: Discussionmentioning

confidence: 99%

“…The stricter criteria of success in the Vandewalle et al [15] study may have contributed to more office-based interventions, such as early postoperative bleb massage and suture lysis, to fulfill their criteria of success. A previous meta-analysis [11], which included trials by Akkan and Cilsim [22] and Pro et al [23], showed that MMC usage resulted in significantly better control of IOP than anti-VEGF antibodies at the 12-month follow-up [11,22,23]. Of note, Nilforushan et al [24] reported that MMC offered better control of IOP than bevacizumab alone at the 1-month (p < 0.001) and 6-month (p = 0.003) follow-ups.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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Aim: The objective of this study was to evaluate the efficacy and safety of bevacizumab combined with antimetabolite as an adjunctive therapy in primary trabeculectomy for glaucoma. Materials and Methods: PubMed, Cochrane Library, and EMBASE were searched for relevant randomized controlled trials. Efficacy was evaluated by the postoperative mean intraocular pressure (IOP), complete success, and qualified success rates. Safety was evaluated by postoperative complications and surgical interventions. Results: A total of 3 randomized controlled trials were included in the meta-analysis. The primary outcome was postoperative mean IOP at the 12-month follow-up. No significant difference in IOP was found between the bevacizumab + antimetabolite (mitomycin c or 5-fluorouracil) group and the antimetabolite alone group (weighted mean difference –0.27; 95% CI –1.38 to 0.83). There were no significant differences in complete success rates, qualified success rates, postoperative complications, and surgical interventions between the experimental treatment group and the conventional treatment group. Conclusions: Results of the meta-analysis demonstrated that the combination of bevacizumab (1.25 mg/mL) with a regular concentration of antimetabolite did not show more benefit or harm compared with using antimetabolite alone. Further randomized controlled trials are needed to evaluate the efficacy and safety of bevacizumab combined with lower concentrations and a shorter application time of antimetabolite.

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Role of Subconjunctival Bevacizumab as an Adjuvant to Primary Trabeculectomy

Abstract: Although subconjunctival bevacizumab is effective and safe in primary trabeculectomy, IOP control appears to be superior with MMC, in terms of complete success with a target IOP<12 mm Hg and number of antiglaucoma medications required postoperatively.

Cited by 52 publications

References 40 publications

Trabeculectomy with ologen in secondary glaucomas following failed trabeculectomy with MMC: comparative study

Trabeculectomy with ologen in secondary glaucomas following failed trabeculectomy with MMC: comparative study

Subconjunctival PRGF Fibrin Membrane as an Adjuvant to Nonpenetrating Deep Sclerectomy: A 2-Year Pilot Study

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

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