Bevacizumab as an Adjunct to Trabeculectomy in Primary Open-Angle Glaucoma: A Randomized Trial

Area of Science:

• Ophthalmology
• Glaucoma Research
• Surgical Innovation

Background:

• Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness.
• Trabeculectomy is a common surgical procedure to lower intraocular pressure in glaucoma patients.
• Bevacizumab is an anti-vascular endothelial growth factor (VEGF) agent with potential applications in glaucoma surgery.

Purpose of the Study:

• To compare the efficacy and safety of two different administration routes of bevacizumab as an adjunct to trabeculectomy in POAG patients.
• To evaluate the impact of subconjunctival versus topical bevacizumab on bleb morphology and surgical success.

Main Methods:

• A prospective, randomized, masked trial involving 180 eyes of 180 POAG patients.
• Patients received either a single intraoperative subconjunctival dose or a 30-day topical application of bevacizumab.
• Bleb morphology, visual fields, and surgical outcomes were assessed over 24 months.

Main Results:

• Topical bevacizumab (Group II) resulted in significantly lower vascularity scores for bleb areas compared to subconjunctival bevacizumab (Group I) at one year.
• No significant differences were observed between the groups regarding age, sex, or crystalline lens status.
• Both administration routes demonstrated comparable safety profiles and did not adversely affect overall surgical outcomes.

Conclusions:

• Topical bevacizumab administration offers a superior vascularity profile for the bleb one year after trabeculectomy.
• Both subconjunctival and topical routes of bevacizumab appear to be equally safe adjuncts in POAG surgery.
• The choice of bevacizumab administration route does not significantly alter the overall success of trabeculectomy.