Comparison of the use of 5-fluorouracil and bevacizumab in primary trabeculectomy: Results at 1year

Abstract

Background: The present study compared the effects of adjuvant bevacizumab and 5-fluorouracil on the efficacy and safety of trabeculectomy. Design: A nonrandomized, prospective, interventional case study. Participants: A total of 62 patients in two groups undergoing primary trabeculectomy. Methods: In Group 1 (21 primary open-angle glaucoma, nine pseudoexfoliative glaucoma), trabeculectomy was performed with an adjuvant 5% solution of 5-fluorouracil administered for 4min, intraoperatively. In Group 2 (21 primary open-angle glaucoma, 11 pseudoexfoliative glaucoma), trabeculectomy was enhanced with 1.25mg of bevacizumab applied subconjunctivally immediately before and after surgery and again 1 and 7days after surgery. Main Outcome Measures: Intraocular pressure, best corrected visual acuity, visual field index, bleb morphology, cornel endothelial cell count. Results: Mean intraocular pressure was 28.0±8.0mmHg before 5-fluorouracil-augmented trabeculectomy and 27.8±9.5mmHg before bevacizumab-augmented trabeculectomy. After 12months, mean intraocular pressure was 13.6±4.4mmHg in the 5-fluorouracil group and 14.7±4.7mmHg in the bevacizumab group. A 30% reduction of initial intraocular pressure was attained in 86.7% of patients in the 5-fluorouracil group and 78.1% of patients in the bevacizumab group at the end of follow up. No significant differences were noted between the two studied groups with respect to corneal endothelial density, visual field indices and postoperative complications. Conclusions: The 12-month intraocular pressure results showed no significant differences between the two groups of patients after bevacizumab or 5-fluorouracil to augment trabeculectomy. However, to obtain successful intraocular pressure control more patients in bevacizumab group needed medical therapy. © 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists.