title: Anti--vascular endothelial growth factor therapy in glaucoma filtration surgery.
abstract: OBJECTIVE
  To examine evidence supporting the use of vascular endothelial growth factor (VEGF) inhibition in controlling wound healing after glaucoma filtration surgery in primary open-angle glaucoma, to identify the optimum method of administration, and to clarify the potential position of anti-VEGF monoclonal antibodies in comparison with 5-fluorouracil and mitomycin C.
  
  
  METHODS
  Perspective based on an overview of evidence from current peer-reviewed literature.
  
  
  METHODS
  Analysis of evidence from animal studies, in vitro studies, human studies, and from the use of anti-VEGF monoclonal antibodies in systemic disease.
  
  
  RESULTS
  There is evidence that glaucoma patients have elevated levels of VEGF in the aqueous before filtration surgery, that this increases in animals after filtration surgery, and that both can be suppressed in animals by intraocular injection of bevacizumab. VEGF not only has a role in angiogenesis, but also has a direct action on fibroblast activity that may be modified directly at the time of filtration surgery.
  
  
  CONCLUSIONS
  There is evidence for a role for VEGF in wound healing after glaucoma filtration surgery. The optimum route of administration and dosing regimen of anti-VEGF antibodies and their positioning in comparison with 5-fluorouracil and mitomycin C are uncertain. There is some evidence that subconjunctival injection may produce sustained intraocular tissue levels. There is also evidence that bevacizumab may act in synergy with 5-fluorouracil. Although there are no direct comparative studies, it seems unlikely that bevacizumab alone will be as effective as mitomycin C, although bleb morphologic features may be better.
authors.affiliation: Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Mathew
authors.forename: Keith
authors.initials: K
authors.lastname: Barton
mesh_terms: D000477:Alkylating Agents / Q000627:therapeutic use*; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D018463:Filtering Surgery; D005472:Fluorouracil / Q000627:therapeutic use; D005902:Glaucoma, Open-Angle / Q000601:surgery*; D006801:Humans; D016685:Mitomycin / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D000477:Alkylating Agents; D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D016685:Mitomycin; D005472:Fluorouracil