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

Ophthalmology. 2008 Dec;115(12):2141-2145.e2. doi: 10.1016/j.ophtha.2008.06.009. Epub 2008 Aug 9.

Abstract

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.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Angiogenesis Inhibitors / administration & dosage*
  • Antibodies, Monoclonal / administration & dosage*
  • Antibodies, Monoclonal, Humanized
  • Bevacizumab
  • Chronic Disease
  • Combined Modality Therapy
  • Conjunctiva
  • Female
  • Glaucoma, Angle-Closure / drug therapy
  • Glaucoma, Angle-Closure / surgery
  • Glaucoma, Angle-Closure / therapy*
  • Glaucoma, Open-Angle / drug therapy
  • Glaucoma, Open-Angle / surgery
  • Glaucoma, Open-Angle / therapy*
  • Humans
  • Intraocular Pressure
  • Male
  • Middle Aged
  • Pilot Projects
  • Postoperative Complications / prevention & control
  • Prospective Studies
  • Trabeculectomy*
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors
  • Visual Acuity
  • Visual Fields
  • Wound Healing / drug effects

Substances

  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Vascular Endothelial Growth Factor A
  • Bevacizumab