Subconjunctival bevacizumab to augment trabeculectomy with mitomycin C in the management of failed glaucoma surgery

Abstract

PurposeTo provide a feasible solution to the problem of failed glaucoma surgery. The aim was to evaluate the efficacy and safety of the additional effects of a combined surgical approach. This approach augments the application of trabeculectomy with mitomycin C (MMC) by adding subconjunctival bevacizumab injection. The results were compared with those of trabeculectomy with only adjunctive MMC.MethodsA randomized controlled prospective clinical trial included 28 eyes diagnosed with failed scarred bleb of a previous trabeculectomy. The eyes were divided into two equal groups: combined group A, “trabeculectomy with adjunctive MMC and subconjunctival bevacizumab,” and control group B, “trabeculectomy with adjunctive MMC only.” The main outcome results included the cumulative probability of surgical success, intraocular pressure (IOP) values, and number of IOP-lowering medications needed to achieve the target IOP.ResultsGroup A achieved a cumulative probability of complete success of 0.769 and of qualified success of 0.231 at the end of the 24 month study period; group B achieved cumulative probabilities of 0.538 and 0.308, respectively. Group A achieved a lower mean IOP value than group B, with fewer antiglaucoma drugs at all postoperative visits, but this lower value did not reach a statistically significant level (P>0.05). There was no statistically significant difference between both groups regarding best corrected visual acuity, visual field parameters, operative and/or postoperative complications, and additional interventions. No significant adverse effects were caused by this combined approach.ConclusionBevacizumab was not found to add much to the favorable long-term outcome of conventional trabeculectomy with MMC as a solution to the problem of scarred failed bleb.

The Effects of Bevacizumab in Augmenting Trabeculectomy for Glaucoma

“…Through further reading the full text, we ruled out 19 published papers, including 2 nonrandomized controlled trials, 7 retrospective case series, 6 retrospective controlled trials, and 4 prospective case series. Finally, we included 8 RCTs 15 – 22 about use of bevacizumab in augmenting trabeculectomy for glaucoma in the meta-analysis. The process of literature screening was shown in Figure 1 .…”

“…Five studies 16 , 17 , 19 , 21 , 22 reported that masking was done either for the patients or for the practitioners; only 4 studies 16 , 18 , 21 , 22 adequately stated allocation concealment. Six of included studies 15 – 18 , 21 , 22 had stated incomplete outcome data. Furthermore, none of the papers adequately described other bias.…”

“…Characteristics of the 8 trials 15 – 22 were shown in Table 1 . Trabeculectomy were performed under local anaesthesia by experienced surgeons.…”

Evaluation the adjunctive use of combined bevacizumab and mitomycinc to trabeculectomy in management of recurrent pediatric glaucoma

“…Recurrent cases were included in a study performed by Saeed and AboulNasr. 27 At the end of the 24-month follow-up, they found a cumulative probability of 0.769 and 0.231 for complete and qualified success, respectively, in the combined avastin-MMC trabeculectomy group. In comparison, they found cumulative probabilities of 0.538 and 0.308 for complete and qualified success, respectively, in MMC trabeculectomy.…”

Bevacizumab Promotes T-Cell–Mediated Collagen Deposition in the Mouse Model of Conjunctival Scarring

“…12 Studies comprising small numbers of patients who underwent GFS with bevacizumab treatment as an adjuvant antifibrotic therapy produced mixed results in relation to surgical outcome. [13][14][15][16][17][18][19][20] The human data contrasted with the more promising observations obtained in in vitro studies on conjunctival fibroblasts, the main effector cells implicated in fibrosis of the conjunctiva, and in in vivo studies in rabbit models of GFS. [21][22][23][24] The in vivo mechanism(s) for the observed antifibrotic property of bevacizumab is unclear, although these laboratory studies implicated the capacity of bevacizumab to inhibit fibroblast proliferation as well as reduce expression of profibrotic TGF-b and collagen deposition as reasons behind the improved experimental surgical outcomes.…”