Beneficial effects of preoperative intravitreal bevacizumab on trabeculectomy outcomes in neovascular glaucoma.
OBJECTIVE
This study aimed to investigate the effects of preoperative intravitreal bevacizumab (IVB) on outcomes in trabeculectomy for neovascular glaucoma (NVG).


METHODS
Charts for 52 NVG eyes of 52 consecutive patients who received primary trabeculectomy with mitomycin C (MMC) were reviewed. Postoperative follow-up periods for all patients were > or = 4 months. Thirty-two consecutive eyes were treated without IVB (control group) and 20 consecutive eyes received IVB (1.25 mg) 10 +/- 11 days before trabeculectomy (IVB group). The main outcome measures were postoperative intraocular pressure (IOP) and incidence of postoperative complications. Surgical success was defined as IOP< 21 mmHg with or without medication (qualified or complete success, respectively). Failure was defined as IOP exceeding these criteria, phthisis bulbi, loss of light perception or additional glaucoma surgeries. Kaplan-Meier survival analysis with the log-rank test was performed to compare surgical success rates between the two groups.


RESULTS
Complete and qualified success rates at 6 months were 95% versus 50% and 95% versus 75% in the IVB and control groups, respectively. The IVB group achieved significantly better surgical success rates than the control group (complete success, p < 0.001; qualified success, p = 0.026). Postoperative hyphaema on day 1 or hyphaema with a duration of > 1 week occurred significantly less frequently in the IVB group than in the control group (p = 0.009, p = 0.014, respectively). The incidence of serious complications such as endophthalmitis, phthisis bulbi and a marked decrease in visual acuity did not increase in the IVB group.


CONCLUSIONS
This retrospective study showed that preoperative IVB decreased postoperative hyphaema and increased surgical success rates, and thus may be an effective adjunct to trabeculectomy in NVG.
Department of Ophthalmology and Visual Science, Kanazawa University Graduate School of Medical Science, Takara-machi, Kanazawa, Japan.
Yoshiaki
Y
Saito
Tomomi
T
Higashide
Hisashi
H
Takeda
Shinji
S
Ohkubo
Kazuhisa
K
Sugiyama
D000368:Aged; D000867:Anterior Chamber / Q000098:blood supply; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D002832:Choroid Hemorrhage / Q000209:etiology; D005130:Eye Hemorrhage / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D015355:Glaucoma, Neovascular / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006988:Hyphema / Q000517:prevention & control; D056965:Injections, Intraocular; D007429:Intraocular Pressure / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control; D011184:Postoperative Period; D011300:Preoperative Care / Q000592:standards; D012008:Recurrence; D012189:Retrospective Studies; D014130:Trabeculectomy / Q000009:adverse effects; D016896:Treatment Outcome; D014822:Vitreous Body
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D016685:Mitomycin