COMMENTARY

Anti-VEGF Agents as an Adjunct to Trabeculectomy

Shuchi B. Patel, MD

Disclosures

February 19, 2014

Role of Subconjunctival Bevacizumab as an Adjuvant to Primary Trabeculectomy: A Prospective Randomized Comparative 1-Year Follow-up Study

Akkan JU, Cilsim S
J Glaucoma. 2013 May 8. [Epub ahead of print]

Study Summary

The introduction of anti-vascular endothelial growth factor (VEGF) agents into ophthalmology has revolutionized the treatment of many disease processes. Therefore, interest in more widespread applications of anti-VEGF agents in ophthalmology is logical. A study comparing the use of adjunctive subconjunctival bevacizumab with primary trabeculectomy with mitomycin C (MMC) may provide evidence for broader use of anti-VEGF agents.

A randomized prospective trial included 42 patients with primary open-angle glaucoma. Patients underwent primary trabeculectomy with either subconjunctival bevacizumab (2.5 mg/0.1 mL) or topical MMC (0.2 mg/mL for 3 minutes).

Intraocular pressure (IOP) was the primary outcome measure. Secondary outcome measures included the corrected distance visual acuity; number of antiglaucoma medications; postoperative interventions and complications; bleb evaluation; and the percentage of eyes achieving target pressures of 21, 18, 15, and 12 mm Hg at 6 and 12 months postoperatively.

There were 21 eyes in each group. Pre- and postoperative changes in IOP and number of antiglaucoma medications are shown in the Table.

Table. Change in IOP and Medications, Preoperatively vs Postoperatively

Group IOP (mm Hg) P Value No. of Glaucoma
Medications
P Value
Pre Post Pre Post
Bevacizumab 23.9 ± 2.7 13.9 ± 2.8 < .001 2.6 ± 0.7 0.6 ± 0.9 < .001
Mitomycin C 22.9 ± 2.6 12.2 ± 3.2 < .001 2.7 ± 0.8 0.1 ± 0.5 < .001

IOP = intraocular pressure

At 12 months, 7 of 21 (33%) eyes in the bevacizumab group and 15 of 21 (71%) eyes in the MMC group met a target IOP of 12 mm Hg (P = .02). Encapsulation of the bleb was seen in 6 patients (29%) in the bevacizumab group and 2 patients (10%) in the MMC group (P = .23).

Therefore, although bevacizumab has revolutionized treatment of age-related macular degeneration and is safe when administered into the subconjunctival space, it does not appear to be as effective as MMC in terms of achieving IOP-lowering goals with trabeculectomies.

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