Subconjunctival Bevacizumab Versus Mitomycin-C as an adjunctive therapy to Trabeculectomy in Open Angle Glaucoma

Abstract

Background: Glaucoma is one of the leading causes that lead to blindness worldwide. Purpose: To compare the outcomes of sub-scleral trabeculectomy (SST) with subconjunctival Bevacizumab versus Mitomycin-C (MMC) in cases with bilateral primary open angle glaucoma (POAG). Study design: case series comparative study. Methods: We collected data from 60 eyes of 30 patients that were diagnosed as POAG and treated with SST and adjunctive therapy was used either with subconjunctival bevacizumab or topical intraoperative mitomycin-C, in the period from January 2021 to February 2022. We analyzed outcomes of this procedure as intraocular pressure (IOP), glaucoma medications reduction and bleb related complications. Results: The preoperative IOP improved significantly from 29.86±4.86 mm Hg to 11.8±2.17 mm Hg at 6th month and to 12.03±1.99mm Hg at the last follow-up in the bevacizumab group, and from 31.3±4.03 mm Hg to 10.8±2.24 mm Hg at 6th month and to 11.4±2.91 mm Hg after one year of follow-up in the MMC group. Both arms showed a significant decrease in the number of antiglaucoma eye drops used at 6 months compared with the preoperative data. In both groups, bleb show a horizontal extension of 2-3 hours, low to moderate height and mild to moderate vascularization. Conclusions: Trabeculectomy with adjunctive Bevacizumab is an effective and safe procedure in patients with POAG. The outcome of SST with MMC and with Bevacizumab was similar in lowering IOP. The complication rates were higher in MMC group than the Bevacizumab group. Bevacizumab is preferred in high risk bleb failure cases.