Bleb vascularity following post-trabeculectomy subconjunctival bevacizumab: A pilot study

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*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

30 Citations (Scopus)

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 (7.5mg/0.15mL) or 5-fluorouracil plus bevacizumab (1.25mg/0.05mL). 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.

Original languageEnglish
Pages (from-to)773-779
Number of pages7
JournalClinical and Experimental Ophthalmology
Volume40
Issue number8
DOIs
Publication statusPublished - Nov 2012
Externally publishedYes

Keywords

  • Bevacizumab
  • Bleb vascularity
  • Glaucoma
  • Trabeculectomy
  • Vascular endothelial growth factor

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