Trabeculectomy with or without Intraoperative Sub-conjunctival Injection of Bevacizumab in Treating Refractory Glaucoma

Abstract

Purpose: To evaluate the efficacy of intraoperative sub-conjunctival injection of bevacizumab as an adjunct regiem to trabeculectomy for the treatment of refractory glaucoma. Design: Prospective randomized clinical trial. Patients and Methods: Fifty-five consecutive eyes scheduled for trabeculectomy were randomly included. In the study group (n= 30), bevacizumab (0.05 ml, 1.25 mg) was injected in the sub-conjunctiva adjacent to the bleb using a 30-gauge needle and tuberculin syringe immediately after the surgery. In the control group (n= 25) surgery was completed without bevacizumab injection. Surgical success was defined as a complete success if the intraocular pressure (IOP) was 21 mm Hg or less with an IOP reduction of greater than or equal to 20% without anti-glaucoma medications. Success rates in both groups were compared using Kaplan-Meier survival curves and the log-rank test. The morphologic characteristics of the filtering blebs were evaluated using the Indiana Bleb Appearance Grading Scale. Results: Fifty-five eyes completed the study, with a follow-up of 12 months. Complete success rates were 73.3% for the study group and 70.0% for the control group (P=0.67) at 12 months. Reduction in vascularity of the filtering blebs was statistically significant in the study group (P=0.001). IOP measurements and postoperative complications in both groups were not significant at all visits (P>0.05). Conclusions: Trabeculectomy with intraoperative sub-conjunctival injection of bevacizumab may offer a useful option for improving the outcome of filtering bleb in refractory glaucoma. Keywords: