Post-trabeculectomy topical bevacizumab preventing bleb failure: a preliminary study.

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Vascular Endothelial Growth Factor (VEGF) Inhibition

Background:

• Trabeculectomy is a common glaucoma surgery to reduce intraocular pressure (IOP).
• Bleb failure, often due to fibrosis, can compromise the long-term success of trabeculectomy.
• Modulating wound healing processes is crucial for optimizing surgical outcomes.

Purpose of the Study:

• To evaluate the efficacy and safety of topical bevacizumab in preventing bleb failure post-trabeculectomy.
• To assess the impact of bevacizumab on intraocular pressure (IOP) and bleb morphology.
• To determine the duration of bevacizumab's effect on IOP control.

Main Methods:

• A prospective study involving 23 patients undergoing trabeculectomy.
• Postoperative instillation of topical bevacizumab (0.25 mg) five times over four weeks.
• Comprehensive ophthalmic examinations including visual acuity, IOP, and bleb morphology at baseline and follow-up visits for six months.

Main Results:

• All patients achieved target IOP, maintained for six months without anti-glaucoma medication.
• Mean IOP decreased significantly from 27.27 ± 8.92 mmHg preoperatively to 8.77 ± 0.97 mmHg at 3 months and 9.27 ± 1.16 mmHg at 6 months (p=0.00).
• A stable, low filtering bleb was observed throughout the study period; cup-to-disc ratio and visual fields remained unchanged.

Conclusions:

• Post-trabeculectomy topical bevacizumab is effective in preventing bleb failure and achieving sustained IOP reduction.
• Bevacizumab's anti-fibrotic properties appear to modulate wound healing stages, contributing to successful trabeculectomy outcomes.
• Topical bevacizumab represents a safe and effective adjunct therapy for enhancing trabeculectomy success in glaucoma management.