Evaluation of Subconjunctival Bevacizumab as an Adjunct to Trabeculectomy: A Pilot Study
Presented in part at: American Academy of Ophthalmology Annual Meeting, November 2007, New Orleans, Louisiana.
Received 6 February 2008; received in revised form 3 June 2008; accepted 3 June 2008. published online 11 August 2008.
Purpose
To determine whether bevacizumab can reduce bleb failure in patients undergoing first-time trabeculectomy for primary open-angle glaucoma (POAG) or chronic angle-closure glaucoma (CACG).
Design
Nonrandomized, open-label, prospective, interventional case series.
Participants
Twelve individuals (7 males; 5 females) with a diagnosis of POAG or CACG, a recorded intraocular pressure (IOP) of more than 21 mmHg (between 10 am and 12 pm), glaucomatous damage on visual field or optic disc, and taking a maximum tolerated dose of IOP-lowering medication.
Intervention
Unilateral trabeculectomy with subconjunctival injection of bevacizumab (0.05 ml, 1.25 mg) adjacent to the bleb using a 30-gauge needle and tuberculin syringe administered immediately after trabeculectomy.
Main Outcome Measures
Treatment success (unmedicated IOP of 6 to 16 mmHg inclusive) at 6 months; bleb characteristics according to the Moorfields bleb grading system on days 1, 7, 30, 90, and 180; incidence of postoperative intervention with 5-fluorouracil or mitomycin C; bleb needling; and incidence of and time to surgical failure.
Results
Mean age was 54.6±13.6 years. The mean preoperative IOP was 24.4±7.1 mmHg (range, 12–44 mmHg) and the patients were taking an average of 2.7±1.6 IOP-lowering medications (range, 1–4). The mean postoperative IOP was 8±3.1 mmHg (range, 4–13 mmHg) on day 1, 9.4±2.7 mmHg (range, 6–14 mmHg) on day 7, 10.9±2.8 mmHg (range, 8–16 mmHg) at 1 month, 10.3±2.5 mmHg (range, 7–14 mmHg) at 3 months, and 11.6±2.2 mmHg (range, 8–14 mmHg) at 6 months follow-up with no IOP-lowering medications. Preoperative best-corrected visual acuity was 0.70±0.3, whereas at 6 months after trabeculectomy, it was 0.66±0.3 (P = 0.39). After a mean follow-up of 182 days, of the 12 eyes, a successful trabeculectomy with respect to IOP control was observed in 11 eyes (92%), with an average IOP reduction of 52%.
Conclusions
In this pilot study with a small number of subjects, 6-month outcomes suggest that subconjunctival bevacizumab is a potential adjunctive treatment for reducing the incidence of bleb failure after trabeculectomy.
Financial Disclosure(s)
The authors have no proprietary or commercial interest in any materials discussed in this article.
ABSTRACT