1. EFFICACY OF SUBCONJUCTIVAL BEVACIZUMAB ASSOCIATED TO MITOMYCIN-C ON GLAUCOMA FILTERING SURGERY. Juan Carlos Mesa-Gutiérrez, MD, PhD, FEBOphth, FICOphth Hospital Esperit Sant, Barcelona, Spain
Comparative study
BACKGROUND
RESULTS
Systemic bevacizumab has been associated with an increased rate of wound dehiscense of colo-rectal anastomosis suggesting that anti-VEGFs may have wound-healing modifying properties. Recent experimental studies in animal models and one short-term study of subconjunctival bevacizumab after trabeculectomy appear to confirm that it may have inhibitory effect on postoperative scarring.
Both groups showed significant reduction in mean intraocular pressure at the end of follow-up period. However, the MMC+BSC group had 72% patients with complete success as opposed to 53% in control group. In bevacizumab group, bleb vascularity increased progressively over the end of follow-up period. One patient showed a local conjunctival necrosis.
Mean IOP (mmHg)
MMC
MMC+BSC p
IOP (1 month)
12,2 ± 3,7
13,2 ± 4,8
0,73
IOP (3 month)
12,4 ± 4
10,8 ± 3,5
0,48
IOP (6 month)
11,5 ± 4,4
10,7 ± 3,7
0,43
IOP (12 month)
12,2 ± 4,9
12,8 ± 2,6
0,32
IOP (18 month)
12,6 ± 3,6
11,8 ± 3,8
0,46
IOP (24 month)
11,9 ± 4,6
10,8 ± 3,9
0,37
IOP (final)
15 ± 4,9
12 ± 4,6
0,39
Baseline characteristics
MMC
MMC+BSC p
IOP
20,8 ± 8,7
19,4 ± 7,5
0,49
Number of preop medications
3 ± 1,1
3,1 ± 1
0,47
Follow-up (months)
48± 24
36 ± 12
0,21
OBJECTIVE
To analyze the safety and efficacy of bevacizumab (1.25 mg/0.05 mL) versus mitomycin C (MMC) for preventing bleb failure in patients undergoing trabeculectomy or nonpenetrating deep sclerectomy for primary open-angle glaucoma.
Postoperative surgical intervenctions
MMC
MMC+BSC p
Needling 4 2
0,02
Suture lysis 6
0,70
Goniopuncture 7
0,90
Surgical revision 1
Hypotony
0,75
Conjunctival necrosis
0,50
Medical treatment 3
0,52
Comparison IOP reduction
MMC
MMC+BSC p
Final IOP
15 ± 4,9
12 ± 4,6
0,38
% IOP reduction
30,29%
39,18%
0,42
Number of postop meds
0,9 ± 0,8
0,4 ± 0,3
Complete success
53%
72%
0,02
METHODS AND MATERIALS
- Prospective study.
Forteen patients with primary open-angle glaucoma were recruited between May 2009 and June To overcome bias only those patients where same procedure in both eyes was performed were included. One group received conventional 0.02% MMC (n=14) and was considered the control group; the second eye received a subconjunctival injection of bevacizumab (1.25 mg in 0.05 mL) at the end of surgery (n=14).
IOP changes were compared with ANOVA for repeated measures.
- Patients were followed up for 24 months. The primary outcome measure was treatment success and bleb morphology in the study eye at 24-month follow-up.
- Complete success: maintenance of intraocular pressure less than 18mmHg and a 20% decrease from preoperative levels and no postoperative goniopuncture or medications. Partial success: intraocular pressure less than 18mmHg and a 20% decrease with or without goniopuncture or medications.
Bleb characterystics (Moorfield’s System)
Central area
Max area
Height
Vascularity 1
Vascularity 2
Vascularity 3
MMC
3,8 ± 1,2
4,2 ± 0,4
1,8 ± 0,3
1,6 ± 0,2
2,2 ± 0,3
2,2 ± 0,4
MMC+BSC
3,7 ± 0,8
4,1 ± 0,3
2 ± 0,2
2,4 ± 0,4
2,6 ± 0,7 p
0,06
0,03
0,45
0,32
0,01
CONCLUSIONS
MOORFIELDS BLEB GRADING SYSTEM
- BSC at the end of surgery may be a useful agent for improving success of filtering surgery and for limiting postoperative procedures on the bleb after filtering surgery. There were no side effects with the use of bevacizumab
LIMITATIONS
- Small numbers, outliers may influence analysis
- Longer follow-ups needed
REFERENCES
1. Seibold L, Sherwwod M, Kahook M. Wound modulation after filtration surgery. Surv Ophthalmol 2012, Vol 57,
2. Vandewalle E, Abegão Pinto L, Van Bergen T, Spielberg L, Fieuws S, Moons L. Br J Ophthalmol 2014;98: 73–78.
3. Mesa-Gutiérrez JC. Estudio de la eficacia del bevacizumab subconjuntival asociado a mitomicina C comparado con mitomicina c en la cirugía filtrante del glaucoma. EV Esp Inv oftal
4. Shaarawy, Sherwood. Hitchings, Crowston. Glaucoma Surgical Management, 2nd Edition. Elsevier
No financial interest to disclose