Intravitreal Bevacizumab Improves Trabeculectomy Survival at 3 Years: Long-term Follow-up from the Bevacizumab in...

To evaluate the effect of a single intraoperative dose of intravitreal bevacizumab (Avastin) on surgical success after trabeculectomy with mitomycin-C (MMC) over 3 years.

Single-center, parallel, double-masked, randomized, placebo-controlled trial. The setting was a single ophthalmic outpatient referral center within a tertiary teaching hospital.

Patients requiring primary or redo trabeculectomy or phacotrabeculectomy for progressing glaucoma. Patients were randomized to a single intraoperative intravitreal injection of Avastin (1.25 mg in 0.05 mL) or placebo (balanced salt solution 0.05 mL).

The primary outcome was treatment success, which was defined by "complete success" when intraocular pressure (IOP) remained less than a predefined target IOP without the requirement of topical medication or "qualified success" when topical medication was required to meet the predefined target IOP threshold.

From a total of 131 patients randomized to bevacizumab (Avastin; n = 65) or placebo (n = 66), 111 patients completed 36 months of follow-up (85%). At 36 months, trabeculectomy survival was higher in the bevacizumab cohort (hazard ratio [complete success] = 0.17, P = 0.002; [qualified success] = 0.07, P = 0.03). Within the placebo cohort, the requirement for topical therapy was higher at 3 months (P = 0.008), 6 months (P = 0.009), 12 months (P = 0.007), and 36 months (P < 0.005).

Bevacizumab was given as a single intravitreal dose during trabeculectomy with MMC resulting in improved surgical success at 36 months postoperatively.

The author(s) have no proprietary or commercial interest in any materials discussed in this article.