Bleb vascularity following post-trabeculectomy subconjunctival bevacizumab: a pilot study.

Abstract

BACKGROUND:

To determine whether postoperative subconjunctival bevacizumab significantly alters bleb vascularity.

DESIGN:

A randomized, prospective interventional study.

PARTICIPANTS:

Forty-three eyes from 39 patients were recruited, with 21 eyes randomized to subconjunctival injections of 5-fluorouracil, and 22 eyes to combined 5-fluorouracil/bevacizumab.

METHODS:

All patients who underwent uncomplicated primary antimetabolite augmented trabeculectomy who subsequently required postoperative subconjunctival 5-fluorouracil injection within 4 weeks of surgery were eligible. Patients were randomized to receive subconjunctival 5-fluorouracil only (7.5 mg/0.15 mL) or 5-fluorouracil plus bevacizumab (1.25 mg/0.05 mL).

MAIN OUTCOME MEASURES:

Primary outcome was bleb vascularity with secondary endpoints including visual acuity, intraocular pressure, bleb morphology, complications and total numbers of 5-fluorouracil injections were recorded at baseline, week 12 and 18 months.

RESULTS:

At week 12, there was no significant difference between groups for visual acuity, intraocular pressure, bleb vascularity and morphology, or total number of 5-fluorouracil injections. By 18 months, 47.4% of the 5-fluorouracil/bevacizumab group exhibited central bleb avascularity compared with 21.1% of the 5-fluorouracil group (Fisher's exact test, P = 0.17). Two bleb complications (one blebitis; one suture abscess) recorded in the 5-fluorouracil/bevacizumab group.

CONCLUSIONS:

After a single combined injection, a trend for increased central bleb avascularity was observed, although this effect was not sufficient to reach statistical significance. This, in addition to the occurrence of two bleb-related complications in the bevacizumab group, suggests the need for a larger clinical trial to further evaluate the safety and efficacy of bevacizumab as a modulating agent in glaucoma filtration surgery.

• Authors: Brian E Chua, Dan Q Nguyen, Queena Qin, Jonathan B Ruddle, Anthony P Wells, Nuwan Niyadurupola, Viney Gupta, Tina T Wong, Michael A Coote, Jonathan G Crowston
• Journal: Clinical & experimental ophthalmology (Clin Exp Ophthalmol) Vol. 40 Issue 8 Pg. 773-9 (Nov 2012) ISSN: 1442-9071 [Electronic] Australia
• PMID: 22429268 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.

Chemical References

• Angiogenesis Inhibitors
• Antibodies, Monoclonal, Humanized
• Antimetabolites
• VEGFA protein, human
• Vascular Endothelial Growth Factor A
• Bevacizumab
• Fluorouracil

Topics

• Aged
• Angiogenesis Inhibitors (therapeutic use)
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Antimetabolites (therapeutic use)
• Bevacizumab
• Conjunctiva (drug effects)
• Drug Therapy, Combination
• Female
• Fluorouracil (therapeutic use)
• Glaucoma (surgery)
• Humans
• Injections
• Intraocular Pressure (physiology)
• Male
• Middle Aged
• Pilot Projects
• Prospective Studies
• Surgical Flaps (blood supply)
• Tonometry, Ocular
• Trabeculectomy
• Vascular Endothelial Growth Factor A (antagonists & inhibitors)
• Visual Acuity (physiology)
• Wound Healing (drug effects)