Evaluation of subconjunctival bevacizumab as an adjunct to trabeculectomy a pilot study.
OBJECTIVE
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).


METHODS
Nonrandomized, open-label, prospective, interventional case series.


METHODS
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.


METHODS
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.


METHODS
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.


BACKGROUND
The authors have no proprietary or commercial interest in any materials discussed in this article.
Grewal
Dilraj S
DS
Grewal Eye Institute, Chandigarh, India. dilraj@gmail.com
Jain
Rajeev
R
Kumar
Harsh
H
Grewal
Satinder Pal Singh
SP
D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003228:Conjunctiva; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005902:Glaucoma, Open-Angle / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D014130:Trabeculectomy; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D014794:Visual Fields; D014945:Wound Healing / Q000187:drug effects
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab