Ophthalmology
Volume 115, Issue 12 , Pages 2141-2145.e2, December 2008

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.

  • Dilraj S. Grewal, MD

      Affiliations

    • Grewal Eye Institute, Chandigarh, India
    • Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, Florida
    • Corresponding Author InformationCorrespondence: Dilraj S. Grewal, MD, Grewal Eye Institute, SCO 166-169, Sector 9-C, Chandigarh, India 160009
    • ,
  • Rajeev Jain, MD

      Affiliations

    • Grewal Eye Institute, Chandigarh, India
    • ,
  • Harsh Kumar, MD

      Affiliations

    • Grewal Eye Institute, Chandigarh, India
    • ,
  • Satinder Pal Singh Grewal, MD

Received 6 February 2008; received in revised form 3 June 2008; accepted 3 June 2008. published online 11 August 2008.

Available online: August 9, 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.

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 Manuscript no. 2008-180.

 Financial Disclosure(s): The authors have no proprietary or commercial interests in any materials discussed in this article.

PII: S0161-6420(08)00559-9

doi:10.1016/j.ophtha.2008.06.009

Ophthalmology
Volume 115, Issue 12 , Pages 2141-2145.e2, December 2008

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