Trabeculectomy Augmented With Anti-VEGF Improves Surgical Outcomes in Glaucoma: A Systematic Review and Meta-Analysis

Area of Science:

• Ophthalmology
• Surgical Innovation
• Glaucoma Management

Background:

• Trabeculectomy is the standard glaucoma surgery but faces variable success due to fibrosis.
• Antivascular endothelial growth factor (anti-VEGF) agents are explored to improve surgical outcomes.
• Fibrosis and scarring at the surgical site limit trabeculectomy efficacy.

Purpose of the Study:

• To compare trabeculectomy augmented with anti-VEGF agents versus standard trabeculectomy.
• To evaluate the efficacy of anti-VEGF agents in enhancing trabeculectomy success.
• To assess the impact of anti-VEGF agents on intraocular pressure (IOP) reduction and medication needs.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials.
• Searched Medline, EMBASE, and Web of Science for relevant studies.
• Analyzed complete and qualified success rates, IOP reduction, and medication reduction at 6, 12, and 24 months.

Main Results:

• Trabeculectomy with adjunctive mitomycin C (MMC) and anti-VEGF showed higher complete success rates at 12 months (OR = 1.90, P = .01).
• Bevacizumab, an anti-VEGF agent, was associated with improved complete success (OR = 1.58, P = .03) at 12 months.
• Combined MMC and bevacizumab significantly reduced IOP-lowering medication requirements (MD = 0.34, P = .008).

Conclusions:

• Anti-VEGF agents, particularly bevacizumab, improve trabeculectomy outcomes when used with Mitomycin-C.
• This combination enhances complete success rates and reduces medication dependency in glaucoma patients.
• Further research with standardized protocols is recommended to solidify these findings.