Efficacy of Bevacizumab Compared to Mitomycin C Modulated Trabeculectomy in Primary Open Angle Glaucoma: A One-Year Prospective Randomized Controlled Study.
To compare the efficacy of bevacizumab over mitomycin C (MMC) modulated trabeculectomy in cases of primary open angle glaucoma (POAG).



In this prospective randomized controlled study, 80 eyes of 80 patients with uncontrolled POAG or intolerant to antiglaucoma medications were randomized to two groups: Group 1 (n = 40) patients underwent trabeculectomy modulated with MMC (0.2 mg/ml), whereas Group 2 (n = 40) patients underwent trabeculectomy modulated with bevacizumab (1.25 mg/0.05 ml). The outcome measures were best corrected visual acuity (BCVA), intraocular pressure (IOP), number of glaucoma medications and bleb morphological features based on Moorfields Bleb Grading System (MBGS). All patients were followed up for one year post trabeculectomy.



The mean preoperative IOP in the bevacizumab group improved from 22.41 ±1.08 mm Hg with 3.2 ± 0.9 glaucoma medications to 13.68 ± 0.79 mm Hg with 0.11 ± 0.32 glaucoma medications at one year (P < 0.001). The mean preoperative IOP in the MMC group improved from 22.64 ± 0.90 mm Hg with 3.1 ± 0.8 glaucoma medications to 13.84 ± 0.73 mm Hg with 0.17 ± 0.38 glaucoma medications at one year (P < 0.001). IOP was comparable between two groups at one year (P = 0.43). No significant differences were found in bleb morphological features based on MBGS regarding central bleb area, peripheral bleb area, height and central vascularity between the two groups at six months and one year. However, there was a statistically significant difference in peripheral bleb vascularity and peripheral non-bleb vascularity with bevacizumab group exhibiting a low degree of vascularity at one year (P = 0.029 and 0.004, respectively).



Adjunctive bevacizumab in trabeculectomy is effective and comparable to MMC for controlling IOP in POAG patients for the first year.
a Department of Ophthalmology , Army Hospital Research and Referral , Delhi Cantt ., India.|b Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India.
Jaya
J
Kaushik
a Department of Ophthalmology , Army Hospital Research and Referral , Delhi Cantt ., India.
Jitendra Kumar Singh
JK
Parihar
c Department of Ophthalmology , Uttar Pradesh Rural Institute of Medical Sciences & Research , Saifai , Etawah , India.
Vaibhav Kumar
VK
Jain
a Department of Ophthalmology , Army Hospital Research and Referral , Delhi Cantt ., India.
Sandeep
S
Gupta
d Department of Histopathology , Fortis Hospital , Vasant Kunj , New Delhi , India.
Pramod
P
Nath
e Department of Histopathology , Uttar Pradesh Rural Institute of Medical Sciences & Research , Saifai , Etawah , India.
Prashant
P
Durgapal
b Advanced Eye Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India.
Jagat
J
Ram
D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D000068258:Bevacizumab / Q000008:administration & dosage*; D003228:Conjunctiva; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D006068:Gonioscopy; D006801:Humans; D007267:Injections; D007429:Intraocular Pressure; D008297:Male; D033401:Microscopy, Acoustic; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D009412:Nerve Fibers / Q000473:pathology; D011446:Prospective Studies; D012165:Retinal Ganglion Cells / Q000473:pathology; D013997:Time Factors; D014065:Tonometry, Ocular; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity
D020533:Angiogenesis Inhibitors; D000903:Antibiotics, Antineoplastic; D000068258:Bevacizumab; D016685:Mitomycin
Bevacizumab; Moorfields bleb grading system; bleb; histopathology; mitomycin C; morphology; primary open angle glaucoma; trabeculectomy