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Bleb vascularity following post-trabeculectomy subconjunctival bevacizumab: a pilot study
Brian E Chua1, Dan Q Nguyen, Queena Qin
1Centre for Eye Research Australia, Department of Ophthalmology, University of Melbourne, and Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.
Clinical & Experimental Ophthalmology
|March 21, 2012
Summary
Postoperative subconjunctival bevacizumab showed a trend toward increased bleb avascularity after glaucoma surgery. However, this did not reach statistical significance and was associated with a higher complication rate.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Vascular Biology
Background:
- Glaucoma filtration surgery success can be limited by scar tissue formation and bleb vascularity.
- Anti-vascular endothelial growth factor agents, such as bevacizumab, are explored to modulate wound healing and improve surgical outcomes.
Purpose of the Study:
- To investigate the effect of postoperative subconjunctival bevacizumab on bleb vascularity following antimetabolite-augmented trabeculectomy.
- To assess the safety and efficacy of bevacizumab as an adjunct to 5-fluorouracil in modulating bleb healing.
Main Methods:
- A randomized prospective study involving 39 patients (43 eyes) undergoing trabeculectomy.
- Patients received either subconjunctival 5-fluorouracil alone or combined 5-fluorouracil and bevacizumab post-surgery.
- Bleb vascularity, intraocular pressure, visual acuity, and complications were evaluated at baseline, 12 weeks, and 18 months.
Main Results:
- No significant differences in visual acuity, intraocular pressure, or bleb vascularity were observed at 12 weeks.
- By 18 months, a trend towards increased central bleb avascularity was noted in the bevacizumab group (47.4%) compared to the control group (21.1%), but this was not statistically significant (P = 0.17).
- Two bleb-related complications (blebitis and suture abscess) occurred in the bevacizumab group.
Conclusions:
- A single subconjunctival injection of bevacizumab combined with 5-fluorouracil showed a non-significant trend towards increased central bleb avascularity.
- The observed trend, coupled with a higher incidence of bleb complications in the bevacizumab group, indicates a need for further investigation.
- Larger clinical trials are warranted to definitively assess the safety and efficacy of bevacizumab in modulating bleb formation in glaucoma surgery.